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You Bet Your Life: An Epilogue to the Cholesterol Story

The first Dietary Goals for the United States (DGUS) were released in 1977 to not a lot of fanfare. At that time, the great unwashed masses hadn’t really heard much about the word cholesterol, a substance the DGUS recommended that we should limit to 300 mg per day. Doctors didn’t routinely screen for it, and if they did, they didn’t pay much attention to it. In fact, at that time – as I recall, anyway – the upper limit of normal for total cholesterol was 240 mg/dl. I was in medical school back then, and I don’t really remember any emphasis on cholesterol or blood lipids. I think we had one lecture on it in biochemistry, given by a nebbish little professor we called Mighty Manford (his first name was Manford), who labored away in the obscurity of the biochemistry department. It’s hard to believe in today’s world of lipophobia that as little as 30 years ago, no one much cared about cholesterol.

One of the major players in bringing cholesterol to the public’s awareness was Time magazine. Its piece on cholesterol in the March 26, 1984 issue was a devastating hit piece on both dietary cholesterol and dietary fat. Both – the article explained – were a main driving force behind the development of heart disease.

Reading this article today, it’s amazing how it drips with misinformation. At the time, however, most people – physicians included – accepted it as gospel. Sadly, even today, many physicians who should know better believe in and act in accordance to the bountiful misinformation contained in this piece.

I could write a blog longer than the article (and it’s a long article) describing and dissecting all the many errors, but I’m going to go over just one. And that one just briefly. But before I get to that, let me show you just a few of interesting small parts of the article beginning with the very first sentence:

Cholesterol is proved deadly, and our diet may never be the same.

Hmm. Dietary cholesterol has been proved pretty benign. But the writers are correct about our diet being changed.

And take a look at this:

For decades, researchers have been trying to prove conclusively that cholesterol is a major villain in this epidemic [heart disease]. It has not been easy.

Have you ever seen a better example of the confirmation bias at work. We know cholesterol is a problem, and we’re going to prove it no matter what it takes. So what if the evidence keeps blowing up in our faces, if we work hard enough, we can by God prove what we know to be true.

Although most cholesterol found in the body is produced in the liver, 20% to 30% generally comes from the food we eat.

Actually, the figure is about 15 percent that comes from the food we eat. Most cholesterol is made in the liver, but not all. Virtually every cell in the body has the ability to make cholesterol, because it is so important to survival.

The main thrust of the article is about a study demonstrating that lowering cholesterol levels brought about a decrease in cardiac death rate. Here it is presented in the breathless prose of the Time writers:

That was the reason for the N.H.L.B.I, study. The elaborate, ten-year program recruited 3,806 men between the ages of 35 and 59, all of whom had cholesterol levels above 265 mg per deciliter of blood (the average for U.S. adults is 215 to 220). Half the men were put on daily doses of cholestyramine, an unpleasant, cholesterol-lowering drug that was mixed with orange juice and taken six times a day. One participant likened taking it to swallowing “orange-flavored sand.” Among its side effects: constipation, bloating, nausea and gas. The other half received a similarly gritty placebo. Researchers had decided to use a drug rather than diet to lower cholesterol, because it would have been virtually impossible to control or measure the diet of so many men over so long a period. By the end of the study, the cholestyramine group had achieved an average cholesterol level 8.5% lower than that of the control group and had suffered 19% fewer heart attacks. Their cardiac death rate was a remarkable 24% lower than that of the placebo group.

The lesson is plain, says Dr. Charles Glueck, director of the University of Cincinnati Lipid Research Center, one of twelve centers that participated in the project: “For every 1% reduction in total cholesterol level, there is a 2% reduction of heart-disease risk.” This, says Project Director Basil Rifkind, is the evidence scientists have been waiting for. “It is a turning point in cholesterol-heart-disease research.”

Pretty powerful stuff, you might think. Which is just what the authors of this article must have wanted you to think. After all, a failed study doesn’t produce cover stories.

There are more than a few flies in this anti-cholesterol ointment, however. Let’s take a look at what Gary Taubes writes about this study in Good Calories, Bad Calories:

In January 1984, the results of the trial were published in The Journal of the American Medical Association. Cholesterol levels dropped by an average of 4 percent in the control group – those men taking a placebo. The levels dropped by 13 percent in the men taking cholestryramine. In the control group, 158 men suffered non-fatal heart attacks during the study and 38 men died from heart attacks. In the treatment group, 130 men suffered non-fatal heart attacks and only 30 died from them. All in all, 71 men had died in the control group and 68 in the treatment group. In other words, cholestryramine had improved by less than .2 percent the chance that any one of the men who took it would live through the next decade. To call these results “conclusive,” as the University of Chicago biostatistician Paul Meier remarked, would constitute “a substantial misuse of the term.” Nonetheless, these results were taken as sufficient by Rifkind, Steinberg and their colleagues [those who had been searching for ‘proof’ for decades that cholesterol causes heart disease] so they could state unconditionally that [Ancel] Keys had been right and that lowering cholesterol would save lives.

Aside from the lack of any real meaningful data, the authors tried to palm off what they had found from a drug study as being applicable to diet. Again, from Good Calories, Bad Calories:

Pete Ahrens [a cholesterol researcher at Rockefeller University] called this extrapolation from a drug study to a diet “unwarranted, unscientific and wishful thinking.” Thomas Chalmers, an expert on clinical trials who would later become president of the Mt. Sinai School of Medicine in New York, described it to Science as an “unconscionable exaggeration of the data.” In fact, the LRC investigators acknowledged in their JAMA article that their attempt to ascertain a benefit from diet alone had failed.

But that certainly didn’t keep them from trying.

Although there were several people mentioned in the Time article who were examples of the benefits of healthful, low-fat living, the star of the piece had to be Fred Shragai.

Fred Shragai, 59, of Encino, Calif., is a good example. Fourteen years ago, the prosperous real estate developer had a cholesterol level above 300 mg. At the time, he smoked four packs of cigarettes a day, was overweight (202 lbs. on a 5-ft. 5-in. frame) and routinely put in five or six 14-hour, pressure-packed days a week at the office. Rich sauces and fatty meat were his standard fare for both lunch and dinner, and exercise meant reaching under the bed to grab from his stash of pretzels and potato chips. Shragai was a classic candidate for a heart attack, and at the age of 45, he had one. Nine years later he was hospitalized for an operation to bypass five seriously blocked coronary arteries. In desperation, Shragai enrolled himself in U.C.L.A.’s Center for Health Enhancement. By changing the way he lived, he was told, he could lower his cholesterol level and reduce his risk of another heart attack.

There was much to learn. Cholesterol, as Shragai found out, is packaged by the body in envelopes of protein, and only some of these packages are potentially harmful. The main culprit, LDL (for low-density lipoprotein), is the body’s oil truck, circulating in the blood, delivering fat and cholesterol to the cells. Studies have shown that the higher the level of LDL, the greater the risk of atherosclerosis. Another type of cholesterol package is called HDL (for high-density lipoprotein). It appears to play a salutary role, helping remove cholesterol from circulation and reducing the risk of heart disease. Shragai’s goal was to lower his level of LDL and raise his HDL.

Diet was a first step. To begin with, such cholesterol-rich foods as eggs and organ meats and most cheeses can directly add to the level of potentially harmful LDL. Fat has an even bigger impact, although the reasons are not well understood. Saturated fat tends to raise LDL levels. Butter, bacon, beef, whole milk, virtually any food of animal origin is high in saturated fat; so are two vegetable oils: coconut and palm.

Polyunsaturated fats, which are typically of vegetable origin, have the opposite effect; thus corn, safflower, soybean and sesame oils tend to lower the level of potentially dangerous LDL. Fish oils do the same. In the middle are the mono-unsaturated fats such as olive and peanut oils. These may lower LDL slightly, but tend to be neutral.

The amount of fiber in the diet also seems to influence cholesterol levels. “LDL cholesterol can be reduced 20% in people with high levels just by consuming a cup of oat bran a day,” says Dr. Jon Story of Purdue University. However, Story adds, “that does not mean you can go and eat whatever else you want.”

For reasons that are still under study, cholesterol levels are influenced by a number of life-style factors. For instance, regular exercise can significantly raise the level of protective HDL. Alas, a couple of push-ups a day will not do the trick, says Dr. Josef Patsch of Houston’s Baylor College of Medicine: “You need sustained aerobic exercise for 20 minutes at least four times a week to really benefit.” A less strenuous way to raise HDL levels may be to have a daily shot or two of alcohol. “The evidence is indirect,” reports Epidemiologist Stephen Hulley of the University of California at San Francisco, “but social drinkers have HDL levels as much as 33% higher than those found in teetotalers.” On a more sober note, U.C.S.F.’s Dr. Richard Havel warns: “Anyone who recommends raising HDL by drinking is playing with fire.” Stress too has a detrimental effect. Studies have shown that the cholesterol levels of medical students peak at exam time, while accountants hit their high point around April 15.

By applying these lessons, says Shragai, “my life was totally changed.” Today the man who used to love steak says, “I won’t touch it.” At a restaurant, “if I choose fish, I ask the chef to skip the butter or please to sauté it in wine.” Every morning, regardless of weather, the man who once spurned exercise goes for an eight mile, two-hour hike through the wooded mountain trails near his home. He no longer smokes. His workdays average between eight and ten hours, but he insists, “I can absolutely stay away from the tension now. If I feel the pressure, I take off. Business associates get used to it; I set my own pace.” Shragai no longer lives in fear of a sudden heart attack: his blood pressure and pulse rate are down, and most remarkable, his cholesterol level has dropped to an exemplary 195.

Do a little Googling on Fred Shragai and a few things turn up. Apparently, Mr. Shragai, a Holocaust survivor, was quite an interesting character. In addition to being a successful businessman, he donned a Santa suit and entertained children around Christmastime. As described in a December 1990 article in Orange Coast Magazine,

Shragai, in his late 60s, stands 5 feet 5 inches and weighs 165 pounds, down from his former rotund 200-plus since the doctor put Santa on a diet. His beard and twinkling blue eyes are his own, he says proudly.

The article describes Mr. Shragai’s joy in his long-term job as Santa to many of his area’s poor residents. He would visit houses, tell stories and bring presents.

“I’ll do this as long as I possibly can,” Shragai says, his eyes twinkling behind his Santa glasses. “After all, Santa can’t just quit.”

Unfortunately, that wasn’t all that long. Mr. Shragai died of a heart attack about two months later on Feb 8, 1991 at age 66.

You can read about his life in an article in the Guardian written by his daughter as she came to grips with his death.

Many people who were in Mr. Shragai’s condition – overweight, overworked and overfed – bet their lives that the promise made by the Time article would be fulfilled. If they quit smoking, cut the fat from their diets, took up exercise and dropped their cholesterol levels, they would avoid an early death from heart disease. As the Time article said about Mr. Shragai:

[he] no longer lives in fear of a sudden heart attack: his blood pressure and pulse rate are down, and most remarkable, his cholesterol level has dropped to an exemplary 195.

As if these changes undo the risk of heart attack. We can see from Mr. Shragai’s unfortunate case that they don’t.

Basically, he bet his life – literally – on the recommendations of doctors who were responsible for most of the hype in the Time article. It’s hard to say whether he won, lost or broke even on the bet, because we don’t know what the outcome would have been had Mr. Shragai continued on his previous path. Or what would have happened had he gone on a low-carb diet instead. Based on my years of experience, I would bet that he would have done better on the low-carb approach, but, as I say, there is no way to know for sure.

There are a couple of take-home messages from Mr. Shragai’s case. The first is that we don’t really know what constitutes true risk for heart disease. Reduction of blood pressure, weight and cholesterol levels – measures of risk in the estimation of most physicians – didn’t prevent a disastrous outcome. The second, and, in my view, the most important is that when we make nutritional and lifestyle decisions, we are betting our lives that we’ve made the correct decision. Even those maintaining their course are making the decision not to change. Decisions precede actions, and actions definitely have consequences, which means decisions have consequences.

I’m betting my life that saturated fat is good for me and that carbs are bad. I eat a ton of saturated fat and very few carbs (unless I’m being a very bad boy as I was last night when I indulged in some of my granddaughter’s birthday cake). So, if Dean Ornish is right and I’m wrong, I could be in deep trouble and maybe live a dramatically shortened life. But I don’t think so. Why? Because the indications that the low-carbohydrate diet is the correct diet for humans comes from so many different sources. (And that’s not even counting my years of hands-on care of many thousands of patients on such diets.)

If you look at the scientific literature, you find that the low-carbohydrate diet is, at worst, the equal of the low-fat, high-carbohydrate diet and at best triumphs over it in spectacular fashion. If you look at the anthropological evidence, the health of early humans took a turn for the worse when agriculture (read: high-carbohydrate diet) came along. Pasta, even whole-grain pasta, was the fast food of antiquity. If you look at the evolutionary evidence, it’s pretty clear that the forces of natural selection molded us to function optimally on a higher-fat, higher-protein diet. And, finally, if you just look at the human physiology and biochemistry involved, it is clear that a diet high in carbohydrates is not good for us. Looking at all this graphically from one of my slides below, we can see that all the evidence vectors point to a low-carb diet as being the one most optimal for human health. Can a low-fat, high-carb diet make this claim? I don’t think so. Though many misguided vegans try to make such a claim, their arguments are risible.

You can find a few studies that show a low-fat, high-carb diet performs OK, but where is the anthropological, evolutionary and biochemical data to confirm? When deciding what diet to follow, remember: you’re betting your life. Consequently, you should view the diet through the various lenses as laid out in the graphic above. If a new diet looks acceptable through one or two lenses, but not the others, just stick with your low-carb diet and be done with it.

Had Mr. Shragai performed the above analysis, he probably would not have followed the diet he did. As I wrote earlier, we have no idea as to what his outcome would have been had he gone on a low-carb diet instead of a low-fat one, but I can’t help but believe it would have been better. Although Mr. Shragai’s case is that of but one individual, since this vapid 1984 Time article came out launching the jihad against fat and cholesterol, the entire country became unwitting subjects in a long-term experiment testing the hypothesis that a low-fat, high-carbohydrate diet is healthful. And in the intervening 26 years, obesity has skyrocketed and type II diabetes has reached epidemic proportions, leading me and many others to say that the low-fat diet has failed. At least as applied to large groups of subjects.

Let me sum up the take home message with an unrelated story that oddly illustrates the point. When I was taking flying lessons years ago, the tower once told me to cross one runway we were stopped short of and proceed to the next one. I goosed the engine and started across. My instructor pushed on the brakes and stopped us and asked me what I was doing. I said, “The tower told me to proceed to runway 15L.” My instructor said, “Yes, but you didn’t look for traffic coming in on runway 15R (the runway we had to cross) before proceeding. Here’s what you’ve got to learn. If the pilot make a mistake, the pilot dies; if the control tower makes a mistake, the pilot dies. Always check for yourself.”

Sobering words, but ones I remember. The same applies to diet. Don’t let Time magazine or anyone else tell you what to do. It’s your life. Don’t bet it heedlessly.

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251 thoughts on “You Bet Your Life: An Epilogue to the Cholesterol Story”

Very entertaining and educational as usual. I think that we can say beyond a shadow of a double what the risk factors are, we just have to use an enlightened reductionism and put the pieces together with good science. That means knowing what the effects of different foods are on different biomarkers and then knowing what effects biomarkers have on disease not only alone but in tandem. But of course “oooooh look at the pretty trend line” seems to be all the media and the public care for or can understand. Shameful!

One question I have for you. I recently found a copy of the original Protein Power book at a garage sale and enjoyed it a lot, I haven’t read the Lifeplan yet but I will when I get the cash. Anyway you seem to be siding with Bary Sears in the 90s that linoleic acid isn’t necessarily a bad thing if Delta-5 desaturase isn’t over-stimulated by high insulin since it doesn’t convert to arachidonic acid. But there is plenty of evidence that it is highly atherogenic and causes cellular DHA deficiency as well as antagonizing thyroid hormone reception and making life generally miserable. Most notably in Chris Masterjohn’s recent article on PUFAs here http://www.westonaprice.org/know-your-fats/2021-precious-yet-perilous.html What is your official opinion of linoleic acid rich oils these days?

I follow your 1996 Protein Power book almost religiously [except fact that I follow it because it makes sense to me, and not because of blind faith 😉 ]. I have read several books of yours too.

Other than your opinion on linoleic acid,
(1) has your position regarding the MAIN points in 1996 Protein Power changed over the years too (such as daily minimum protein requirement, etc)?
(2) and, if so, what are your current positions on such issues?
(3) is your current position on nutrition stated more accurately in any of your later books compared to y’all’s 1996 Protein Power?

Probably not much has changed from the main points in PP except for some of the info on fats. My current position on most issues can be found in the Protein Power LifePlan. Ignore the exercise chapter, but the rest is pretty up-to-date.

The WAPF article seems to say that in adults the requirement for fatty acids is rather low (though it doesn’t say how low). It also says that large doses of Omega 3 fish oil can be harmful if continued for over a year. So the article seems to contradict the consensus in the low carb community that the majority of one’s diet should consist of fat and protein (how much of one vs. the other is still in dispute).

This is important to me because my BF and I came to the decision over the weekend after much research and agonizing (Dr. Eades is right, we’re betting our lives) that he would be better off not taking the statin his cardiologist has had him taking for the past year, and use a modestly high dose of fish oil (2,000mg omega-3) to get his triglycerides down. His numbers are HDL 48, TC 340, TG 330, LDL 226 (calculated). He also has occasional atrial fibrillation and his TSH is 6.35. We switched him to low carb at the same time. He’s an Atkins veteran and has no trouble sticking to the diet.

I realized we’re using fish oil medicinally here, which I hate to do without medical advice, but the only the medical advice available in our neighborhood is the usual lipophobia. But the Masterjohn article made me pause. Thanks Dr. Eades for pointing up the seriousness of the decisions we make regarding what to put in our mouths–it really is life and death.

Oh-my-good-god Lacie!! “his TSH is 6.35” Please both of you go immediately to the website Stop the Thyroid Madness (STTM) — which is a SUPERB resource about thyroid. (If 1,000 people find something works, you might consider trying it.) The TSH test, which docs mostly agree tends to be “somewhat inaccurate” {eye roll}, I analogize this way:

The TSH is a pituitary hormone — it’s the pituitary shouting out the window like a farmwife to the thyroid (the worker in the field) that lunch is ready (body needs some thyroid released into the blood). And then the doc decides that the farmworker has been fed (your thyroid is normal) — because he was called (you have TSH in your serum — the yelling part, not the results part, yes?)!

Now, suppose the farmworker didn’t hear the call (the thyroid is non-responsive, or barely responsive).

Suppose the farmworker can’t get to the house for lunch (the thyroid is exhausted and can’t ‘move out’ some T4, T3, T3, T1, and calcitonin).

Suppose the farmworker heard the call, came to the house — but for some reason can’t eat anything (your tissues are thyroid resistant,non-responsive, barely responsive).

Your doctor will say: “eh, you’re fine, you’ve ‘eaten’ — see? The TSH shows you were ‘called’!” Even though NOTHING (effective) has happened!

Your BF’s TSH us very high! They keep dropping the “thyroid needs treating” level: currently most labs put the top at 3 or lower… (And your doctor will be *completely uneducated* (esp. if he’s an endocrinologist) about this!) (How like most docs and nutrition knowledge, eh?)

Elenor, thank you. I knew there would be some knowledgable people on this forum who could point me in the right direction. The sad thing is that neither his cardiologist nor his general practitioner called him about the TSH numbers on the lab report after it came back even though it had “H” next to it because it was out of “normal range” (“normal” varies depending on the lab, but 4.5 was the upper limit on his). I had to read the lab report myself a month after he got it, do some research, and tell him OMG your TSH is sky high and you need to move on this. In a way I’m glad it’s out of range, because it’s more likely that he can at least get someone to pay attention, but I already have a fair idea of what 99% of docs will do (T4 test and supplemental T4 if warranted, blah to T3). Time to start doc shopping.

Thank you for the link and your great metaphor describing the process.

I originally had pretty good luck with my doc (who was listed as possibly a good one on the thyroid list) — I went in (armed with all the info I’d read and) with my blood test results from http://www.lef.org (I have them send the results directly to me and I make a copy for my doc — I want to keep him in mind that *I* am driving this bus!), and with the recommended dosing schedule from STTM.

I showed him my tests, told him I wanted to try dessicated thyroid (Armour back then, but they’ve changed it and Armour is crap now; I ended up using Canadian Erfa) and treat my adrenals (ended up taking physiological (not treatment!) doses of hydro-cortisone). I showed him the dosing schedule and asked if it was okay with him to follow it. (He read it and said sure.) So, he was pretty willing to go along with whatever I suggested or asked. (Later, I was very dismayed when a woman I’d recommended him to went in and he recommended synthcrap to her!) I think I got the treatment I wanted because I started out telling him what I wanted — she just asked him for help…

I’ve mostly quit seeing him. I’ve gone on to treating Reverse T3 with T-3 only –about which he knows nothing: he would only write a script for 90 days and it takes 12 weeks to clear rT3 from the tissues. {eye roll}) So, I get it from Mexico (German made T3 only).

I’m not thrilled about self-treating, but as with diet advice, you have to find people you trust (thank you Drs. Mike and Mary Dan!!) and go your own way.

(p.s., I was tempted to quit lef.org, but their prices are so good on vitamins and blood tests — I’ll stay.

This is another example of a critical instance when you need to treat the patient and not the lab value. I went through a decade of having my thyroid meds adjusted to my TSH levels, all while complaining quite constantly to the docs (including specialists) about not feeling better. I finally found an anti-aging hormone specialist who immediately put me on Cytomel T3 and the difference was drastic. Any reader of this blog knows that you unfortunately have to become your own expert, whatever your health concern. It’s no different for thyroid than diet; the docs will happily treat your thyroid lab values, regardless of how your feel, and probably put you on an anti-depressant for the remaining symptoms. They are woefully I’ll informed of the latest research, and generally react badly when a well researched patient shows up. Don’t give up, and don’t give in. Keep searching for that gem of a doctor that all listen and think.

I had a doctor tell me that my TSH of 7.25 was “a little above normal.” He refused to give me thyroid medication even though I had all the clinical signs of hypothyroidism, and he tried to bully me to go on Prozac. I told him to go stuff it and walked out of his office. Long story short, after years of feeling like crap because of low thyroid, I started taking iodine and it was like getting a new lease on life.

Yes I caught recently that WAP himself said that cod liver oil seems to have toxic effects if taken continuously for too long. I believe that this is due the build up of PUFA in cells, including omega 3s, that counteract the temporary benefit of vitamins A and D. I suspect that actually no PUFAs are “essential”, and are all toxic to some degree, based on Ray Peat articles such as this one: http://raypeat.com/articles/articles/unsuitablefats.shtml. Vitamins A and D are great, of course, but we have to remember that cod liver oil, not to mention fish pills, is not a natural food. Sea food from warmer waters, where we probably evolved, actually does not contain much PUFA at all.

Vitamin D is not so good. For this reason Fish Oil isn’t also.
Vitamin D is not a Vitamin, it is a hormone. Actually it is a steroid hormone (precisely secosteroid!) and has many immunosuppressive properties.

I’d say, use cod liver oil, which has the benefit of tradition.
The thing is that EPA and DHA are only part of fish oil, and the rest is the PUFA you don’t want. So feeding with fish oil as a major calory source is highly inflammatory. But DHA and EPA by themselves are not.
You could also try krill oil, which saturates membranes at significantly smaller doses due to the DHA and EPA being in phospholipids.
I don’t believe that fish oil in dietary amounts is harmful, and dietary amounts of DHA and EPA can be quite high.
You just need lots of saturated fats to balance them out, and of course lipid antioxidants; tocopherols, tocotrienols, carotenoids, selenium.

You can bring your triglycerides down by adopting a strict low carb diet with lots of saturated fat in the form of coconut oil. You don’t even have to take fish oil to achieve that. I had TGs in the 700 range in 2003 before going low carb (<30 gm daily of carbs) and my TG last month came back at 58.

I know someone who studied nursing in the early 1960s. If I remember correctly, she told me her old text book had the upper limit of cholesterol at 300. Maybe the winds of change were already wafting between then and your 1977 number of 240?

Tragic tale of Mr. Shragai. Makes one wonder how many thousands of other such tragic tales there are that we’ll never know about.

I’ve gotten my student license so I can fly alone multiple times, but every time I get toward the end of my pilot training, something comes up and I take what starts out to be a couple of weeks off but turns into a few years off. Then I start again. I’ve probably got enough hours to get a commercial license, but I just need to go in and finish it off. If I ever have the time.

Really enjoy your blog. I love reading about cholesterol ever since I discovered Uffe Ravnskov in about 2001. My doctor had just given me a lipitor prescription. I decided to look into this theory before I embarked on a lifelong regimen of drugs. Boy, am I glad I did.

Do you ever think this ridiculous theory will be completely overturned in our lifetimes? I’m 49 years old.

Rob, I discovered Ravnskov when somebody in my family came home from the doctor with a bunch of Lipitor samples. I can tell you that this ridiculous theory was completely overturned in MY lifetime a long time ago! I’m twenty years older than you.

Beautifully written piece so clear. Born 1955, UK, so brought up on saturated fat and big chunks of cholesterol. Went into healthcare 1973 and believed the medical evidence from around that time and went low fat along with the rest of the free world (still blame the Americans).

Helped spread that message to all the Mr Shragai’s I encountered, whoops sorry. I just lost my lovely skinny look not my life. Still expected give the same message, so works kind of impossible now. Working in healthcare feels like what none communists must have felt like living in the eastern block before the fall of that ideology.

Still here’s hoping I can’t be sued in court for giving such crap advice, but should be alright because of vicarious liability. What a relief !

Gary Taubes’s book found by chance, brought me back to reality and led me to your work. Can’t get anyone at work (hospital) to read GCBC’s cause they have’nt the time, to busy fighting the diseases of civilization. They might read short pieces like this though. Thanks really enjoyed this one for its clarity of message.

My father’s history was similar to that of Mr. Shragai, when he died of a heart attack in 1970. I vaguely remember that some of Ancel Keys’ theory was already in vogue, as my dad was counseled to cut down on meats and other “rich” foods. Too bad no one told him not to eat the giant Hershey cars he kept hidden in his desk at work. And his doctor was ok with my dad switching to cigars from cigarettes, cigars which he presumably wouldn’t inhale. Presumably wrong!

Anyway, what I find exasperating about the “science” of the time and lousy reporting of it was the way they lumped together the charge about dietary cholesterol and fat with surely the worst factor of all, the smoking, and heavy smoking at that. Why should anyone have been surprised that my dad or Mr. Shragai should die of a heart attack even if they had subsequently reformed their diet, lost weight, and exercised regularly as if one could undo the enormous cardiovascular damage from heavy smoking over decades. Yet they came to blame the steak and the eggs!

I chuckled when I read your reference to Mighty Manford. If my memory is correct, you have mentioned you went to medical school at the University of Arkansas in Little Rock. I grew up in Little Rock and “Manfred” Morris was a close family friend. He did research in atherosclerosis and I used to enjoy tours of his lab. And I remember his radical low-fat diet which was quite different from the typical southern diet of the time. My mother struggled to include something he would eat when they came for dinner.

Last week I heard a piece on NPR about the disconnect between nutrition advice and the hard science of fat metabolism. I was encouraged until the “expert” said that the problem is the meat industry still controls the government as it did when the McGovern committee “watered down” it’s recommendations in the 70s. It does no good to scream at the radio, but I did it anyway.

He is one and the same. But his first name was Manford, not Manfred. At the time he lectured to my class, he hadn’t really adopted the low-fat diet – at least not to my knowledge. Wonder how he did on it?

I knew him in the 6o’s when I was growing up and, of course, called him Dr. Morris so I am not surprised I have revised his first name a bit in my memory. Our families lost touch when we moved to Texas so I don’t know whether he continued to follow a low-fat diet. It would certainly be interesting to talk to him about the subject now to see what he learned from his years of research.

Thanks for the informative article. Having read GCBC and discovering this expansive world of nutrition and unfortunately, misalignment of science, my critical thinking skills have been awoken and back to school I am. I relay information learned and it seems to fall on dead ears. People generally seem appreciative of the information but don’t seem to realize the context or implications. It seems there is a blanket of blindness hovering over the collective masses.

Dr. Eades, the one contrary “vector” of evidence I’ve seen is the seemingly excellent health of numerous traditional cultures eating very high-carb, even high glycemic load, diets. Stephan of Whole Health Source has written about some of these cultures. It could be that they are not as healthy as non-agricultural hunter-gatherer societies, but to a very impressive degree they just don’t seem to suffer from the diseases of civilization—even if they eat the majority of their calories as high-glycemic yams or potatoes, for example.

It does seem that for us industrial and post-industrial folks, reducing carbs in general is highly beneficial. Like you, I’m betting my life on that. (As we know, Stephan is not, though he does eschew sugar, wheat, etc.) I’m curious if you have an opinion about the healthy high-carb cultures and how what we know about them fits with the other vectors of evidence you described.

Your comment speaks to the point I made about running any kind of diet through all the lenses. Yes, anthropological evidence shows that there are some societies – not the majority – who seem to do well on higher carb diets. But does that mean that all of us should follow such diets? Not if viewed from the perspective of all the vectors. Evolutionary? Nope, it’s pretty clear from the great mass of evidence that we evolved on a high-fat, high-protein, low-carb diet. Clinical trials? Most of this evidence favors the low-carb diet. Human biochem and physiology? Despite the fact that a few societies seem to thrive on higher-carb diets, human biochem and physiology militate against it. Carbs wreak metabolic havoc.

I often reference your interview with Gary Taubes where he addressed the issue, specifically of Asian cultures, who eat a high carb diet with few incidences of the “diseases of civilization.” He argued that it’s a combination of factors that includes the level of refinement of the carbohydrate (rice in this case) as well as the amount of fructose and/or sugar in the given diet.

For what it’s worth I don’t think modern Asian cultures are immune to the diseases of civilization. You only have to google diabetes and china, diabetes and india, to see how badly those countries are doing.

The Kitavan people come to mind. They consume a lot of tubers plus fruits, vegetables and fish. Coconut is a staple in their diet. They don’t appear to consume legumes or grains. Also, the Okinawans consume plenty of sweet potatoes (about 70% of their calories) in their diet and we all know their health!

For your next book, how about expanding this post into full length book form? Cal it “You Bet Your LIfe”, expand on the four vectors, more stories like poor Mr. Shragai (There’s Tim Russert, for one). Maybe add in a review of the history of the lipid hypothesis.

The most commonly used prescription drugs taken by older (60+) Americans are cholesterol-lowering drugs. A sad state of affairs. Unless, of course, you’re in the business of selling them. Thanks for the post.

Not really. Such studies take a very long time – a lifetime, in fact – to do. The drug studies showing changes in all-cause mortality are generally done in older subjects who already have life-shortening medical problems.

It’s amazing to me how the average person is so willing to defer to ‘experts’ on such important matters. Sure, it’s wise to consider what knowledgeable people have to say, it’s wise to understand the issues, but ultimately, it’s your life, it’s your health, it’s your body — and nobody, I repeat, nobody has more at stake than you do.

Your ‘pilot vs. controller’ story is a perfect example of why you can’t put blind faith in others.

Dr. Mike, I have been sharing the low-carb message with a lot of people over the past few years, and I usually find that people just don’t want to reconsider their low-fat dogma.

What has been frustrating lately is that I have found some people who are a bit more open-minded about changing their diets (and their dogma)… but they swear they’ll die following their doctors’ advice before they’d take nutritional advice from BLOGGERS.

They don’t seem to care that many of the bloggers spreading the low-carb message are doctors, biochemists and real scientists. Or that they have studied the issues more thouroughly than their doctors. Or that they really do know what they are talking about.

Too bad low-carb isn’t a horse. We could make good money betting on this under-rated option! Horse or not, I’ll keep my money on the low-carb diet for the health benefits. Thanks for the great post!!

Ramona,
Bloggers who don’t have medical degrees and higher education are a different story than someone like Dr. Eades. The hippocratic oath is important. People can get their medical licenses revoked for being too wacky. That is not true for people blogging on the Internet. 🙂

Amy,
I appreciate your point. Medical education/licensing and higher education may offer physician bloggers an extra measure of credibility. Many people may be more likely to believe a blogging doctor, who has the fear of losing his medical license to keep him on the up and up.

In a bigger way, though, I really am saying that a medical degree/license is only one thing to consider when evaluating a person’s knowledge or expertise. But it is not the only thing to consider.

A person who has a formal education or a particular degree doesn’t necessarily know more about a topic than a person without that degree. Even uneducated people are entitled to their opinions. And I an entitled to believe them, if they make more sense than the formally educated person’s position.

I am a big believer in self-directed learning. The classroom is not the only place to learn things, and it is not even the best place to learn a lot of things. We all educate ourselves in many ways throughout our lives.

All of the smartest people I know continue to learn all of their lives. They become experts in many topics and acquire many skills that may have nothing to do with their original formal degree, if they even have one.

It doesn’t seem reasonable to discount good information just because it was written by a person without the formal education which typically certifies his expertise on the subject matter. The writer (or blogger, in this case) may have gained true expertise, which is just as valid, in a non-certified manner!

Wasn’t there an article that came out in Time magazine maybe around 1990 that looked at all the cholesterol research and found there was nothing to support all the hype?

I remember this was around the time my mother had a massive stroke and came to live with us in Maine. I was into Jane Brody’s high-carb lifestyle at the time, and bought into all the cholesterol madness. My mother’s doctor put her on cholesterol-lowering drungs, and I made her oat-bran muffins until I was blue in the face.

A friend of ours had mentioned the article to me, saying there’s no basis for all the hype. I got up on my high horse and told him, “Well, I’m believing her doctor over you. He obviously knows more about this than you do.”

Yeah, “obviously.”

Anyway, I’m now converted (obviously!), but was wondering if anyone else remembers the second article that contradicted the first article.

That’s exactly how I think about it: I’m betting my life on it. I’m betting on a billion years of animal kingdom evolution.

What’s the worst that can happen? Well, I’ve seen the worst. Listen carefully to the doctors and they still have no idea if you’ve got, will get, why you got, or how to get rid of cancer. But, damn, you’ll have “exemplary” cholesterol.

given how many in the US are riddled with CAD, it would seem to me that while low carb may be a better diet from a preventative point of view, what about all those who already have a build up of artery plaque? Ornish and Esselstyn show plaque reversal with their diets; can the same evidence of plaque reversal( or stopping progression) be documented or has it been documented with a low carb diet?

Someday I’ll write a post on how bogus these ‘reversing plaque’ claims really are. I have written one post on the subject of the Ornish program overall, but haven’t really gotten into the part about the supposed plaque reversal.

If a high-carb diet causes increased insulin release and, ultimately, chronic hyperinsulinemia (all true), and if hyperinsulinemia is a major risk factor for the development of heart disease (also true), how can a high-carb diet reduce and reverse plaque? It doesn’t make sense. If a low-carb, high-fat diet improves all of the putative risk factors for CV disease, why would such a diet make established heart disease worse? I don’t think it does. As I’ve written before, MD and I have treated approximately 10,000 patients with low-carb diets. The vast majority of these patients were middle aged and at their prime for heart disease. Most of them had multiple risk factors. We treated the average patient for about 12 weeks. If you do the math, it turns out that we have a little over 2300 patient-years on low-carb diets – and not one single heart attack in the bunch.

I was at TrackYourPlaque for 2+yr as an invited guest and quickly discovered what did not work for plaque. I left over the lack of EBCT success in members and when Dr. Davis and I disagreed over saturated fat.

Guess what? As you might have suspected 60 60 60 rarely worked from my clinical observations. What works is saturated fat/cholesterol and lower carb.

LDL<= 60 is completely, hysterically bogus.

When LDL = 60 is done with pharmaceuticals (statins, fibrates) and the AHA 'conventional' low saturated fat diet, the emphasis of the website, then progression of plaque on EBCT occurs annualized, from my observations even in members who have lost signficant body fat 20+ lbs. Egregious??

Many members frequently consumed egg beaters and barely strayed above 300mg dietary cholesterol daily. I think my arguing with him paid off! Early this year Dr. Davis reported that (finally) he discontinued his Crestor. WOW whoa nelly…That is clinically excellent and I commend him. [OTOH The strengths of the site are the collective camaderie and helping hands on the forum, unless of course you are being bullied for promoting an anti-statin and/or high fat approach since no moderation exists except peer.]

Dr. Eades, I rarely observed 'reversing plaque' except in the rare TrackYourPlaque members who already were aware of ProteinPower/primal/evo/paleo/evfit/crossfit diets, read your blog or Uffe Ravnskov or read critically in general. 98% of members who posted results had progression year-after-sad-year, whereas those on lower carb and moderate to high fat (25+% diet saturated, 40-60+% total fat) achieved the coveted regression of EBCT scores within 8 to 12 months. With ease. NO DRUGS (I saw 1-2 cases statin was on board, but lower dosage and of course the saturated fat 25 or higher% which would negate/neutralize partially the adverse effects of statins).

You and MD and your books have been a beacon of enlightenment to help me and other to understand the high value of saturated fats — which are integral parts of the immune system which not only protect against disease, harm, and damage but are VITAL for regeneration.

Ornish?? The blatant lack of saturated fat and the fat-soluble antioxidants which are ONLY found in fatty ancestral foods (CoQ10, vitamin ADEK2, lipoic acid, carnitine, potent carotenoids, etc) IMHO resulted in his cancer and mental decline (I believe he committed suicide from depression). I am no doctor but I strongly believe this lead to his premature demise.

Thanks for the long, thoughtful comment. I’ve always known that low-carb diets improved the putative risk factors for CV disease, but yours is the first report I’ve had of low-carb diet followers actually reducing the mass of their plaque.

I think you meant Pritikin instead of Ornish. Ornish is still kicking as far as I know. Nathan Pritikin did develop cancer and did commit suicide.

ABSOLUTELY! Thanks — I meant Pritikin! Actually I enjoy Ornish however again the dietary fat issue I believe will be subpar advice for the great majority of people who want to avoid cancer/CAD/inflammation.

Reduction of sdLDL to zero (as R Krauss researched) was achieved by low carb (almost no grains or grain-free) and moderate to high sat fats/chol and some exercise/resistance train. (it’s not necessary for regression from my observations but doesn’t hurt)

Those with regression in ~approx 1 yr or less on low carb/high sat fat/chol are few but incl members: dcarrns, sergad, skidude. Those with lower portions/carbs, low to mod sat fat and 10-20+ lbs wt loss (no statins) incl members: hillbrow, lindybill.

Thank you Mike, great post. I’ll link to it with the title “One man’s summary of the non-scientific approach to cholesterol and CVD”. In hind sight, it does seem astonishing that so many intelligent people jumped onto such scant evidence to support the lipid hypothesis. Reminds me of the “you can fool some of the people all of the time, all of the people some of the time” quote.

I bet my life, too, btw. And fwiw, for a guy that had such severe CVD at 45, living to 66 doesn’t seem like a tragedy; however, if his last ten years were negatively impacted because his CVD wasn’t improved by his lifestyle changes, only decellerated, then it would be a tragedy. In other words, my grandmother had serious heart and aortic artery issues in her early 50s, but quit smoking and survived two aortic aneurisms, and lived to be 86. Happy ending? No, her deteriorating health greatly reduced both her life, and her ability to love those around her, and much of it was unnecessary (there were no meaningful dietary guideliness for her).

Perhaps this is a tertiary point, but we talk about mortality because it is “under the lamp light” (measurable). The more meaningful consideration is quality of life. In that perspective, there’s no comparison between low carb and low fat – one is simply superior for performance and well being for every person I know who’s made the conversion (I confess to confirmation bias). If the choice is to feel good and live well, but lose ten years of life (which is the low carb worst case) … I’ll take that bet too. I’m not looking to live for 100 years, with 20 of those in a wheel chair trying to accomodate a wrecked cardio vascular system. Paul
PS – I have nearly 3000 hours in various military aircraft, and sometimes feel chagrinned that good aviation is nearly as simple as ‘look both ways before you cross the street.” Well, that and ‘don’t do stupid stuff.’

Saw an interesting article in Men’s Health while at the dentist’s office. It was about Tony Gonzales, the tight end for Atlanta, and his vegan lifestyle. I didn’t have a chance to read it all (my turn came) but one comment in the article was applicable to this conversation.

I think it was the writer not Gonzales, stating that, and I’m paraphrasing – “everybody has seen these thin wiry guys who are very strong and the reason is because their muscles are lean and not marbled with fat like a good steak” with the premise being eating a vegetable protein based diet as opposed to an animal protein based diet causes lean and “unmarbled” muscles.

This is wrong in so many ways you could probably do a blog on it – starting with what the cow ate to get its muscles marbled with fat.

Although, I think all the scientific evidences you gave for a low carb diet are still trumped by feelings alone, our surest indicator of what’s good for us– if we only pay attention enough to follow them. Science is good, but often scientists are pressured to say “because we got this and this and this data, we therefore know this”. Very often, science has been wrong, and I say it continues to be wrong. Expectation and funding shape science more than actual evidence. In my opinion, you’ve fallen into the same trap you are criticizing this Time article for doing. Science is often useful, but feelings are the ultimate authority on our physical reality. (Tradition is a close second, and since when has tradition been low carb?)

Why do you think you still are compelled to eat this and that, like your granddaughter’s birthday cake? Wouldn’t your body chemistry have changed after all these years? Wouldn’t your old, evil “habits” have disappeared by now?

I think feelings are never wrong. However, our feelings have not adapted to detect what I believe are the true poisons of, say, that slice of birthday cake: polyunsaturated fats (frosting and cake), trans-fats, added iron, a complete lack of vitamins, minerals, and proteins (and fiber?), and who knows what other modern contaminants in the ingredients. Think about the plausibility. Also, you have to drink an awful lot of caffeine every day, don’t you? How natural is that?

Look, I know you’ve got a reputation to protect, but isn’t this why you blog? Are you looking for help, or is this all just PR for your business?

PR for my business? What business? My sous vide business? I almost never mention it in the pages of this blog, and the blog predated the sous vide by years. My practice? I’m not in practice right now, so it can’t be that. My book writing business? All our books sell many more copies than there are readers of this blog, and did so long before there was a blog. I guess I don’t get what you mean by PR for my business.

Feelings? Subjectivity is another word for feelings. And subjectivity is why double-blind, placebo-controlled trials were developed: to remove the subjectivity of both the subjects and the researchers from the equation.

I’m sure I would feel vastly better throughout the day if I were high on marijuana or if I snorted cocaine. Does that make the use of those ‘natural’ substances more healthful than their avoidance? I doubt it. How about smoking? People who smoke obviously enjoy it or they would quit. Their ‘feelings’ tell them to keep on puffing.

I think going by feelings alone is a mug’s game that will lead to no good end, which is why I prefer the science.

I can clearly remember how much better I felt after the first 3 weeks of low-carb, well before any significant weight loss (I lost 40 lbs and have kept it off c 6 years). With hindsight I would go low-carb even without the weight loss, for the mental benefits / joi de vivre. I believe this is a key factor in making low-carb a way of life people can stick with, as opposed to calorie restriction which is sooo hard to keep to. It’s a pity if this dimension can’t be analysed scientifically. IIRC one of the weight loss drugs came out of anti-depressant research – how sweet if the low-carb diet has an anti-depressant effect !

BTW You freely give away such a lot of great material here please don’t let the odd snark touch you

I really appreciate to know that you’re listening. But first off, why act so innocent? You know what I’m talking about– your book business. And all the future books and interviews you may do. But actually I’m sorry I brought that up, because the biggest issue by far is reputation (and sanity). You have a legion of devoted followers who might be quite angry or disillusioned if you started doubting low carb. And if you changed your mind entirely, you’d feel pretty angry and disillusioned yourself, which is why you’re probably afraid to even think it at this point. But please consider my arguments. I know it’s reasonable to dodge some questions that you can’t answer, as you did– if you happen to be right anyways, then why unnecessarily scare the public and cause doubt in yourself? I understand, but please read on.

When I was attacking science, I’m not attacking the double-blind, placebo-controlled trials. I’m talking about the big picture– the picture by which those results are interpreted by. Two of the main pillars you presented above are kind of the same category– the “Anthropological data” and the “Evolution, Natural Selection”. Both of these are pretty flimsy when you get down to the evidence. How can we say what our ancestors or hominins did or didn’t do, based on a few sites here and there in the world, and nothing but stone tools left? To assume that they couldn’t grasp the concept of planning ahead by planting and harvesting, or by keeping animals and milking them, is assuming they were pretty stupid, especially when they had all day to figure out how to avoid hunger and feed more people. As for the cooking issue, a quick look at Wikipedia reveals that some researchers think even Homo ergaster or Homo erectus were making fires. It’s not a great leap to figure out what happens when you put root vegetables like potatoes by the fire. And as for anatomical evidence, such as our digestive system being most like carnivores– even obvious carnivores like cats and dogs are doing pretty darn well on a mostly carb diet, considering that their total time for adapting to it is not more than 100 or so years. I know they’re not doing splendidly– quite probably for the reasons I gave in my last post. But what this goes to show is that animals do not have much problem at all handling glucose, even if they’ve never handled that amount before in their evolutionary history. Our distant hominin ancestors may very well have been total carnivores at one point, but the switch to carbs in their diet would not have been a problem at all, as long as they still had meat too, which is perfectly plausible.

How about our knowledge of “Human Biochemistry, Physiology” from “Clinical Trials”? Even if you ignore the personal testimonies on the internet of higher blood sugar readings when on a low carb diet, and lower when on a high carb diet, consider this: In a recent video that Matt Stone did, he spoke of a study where people with the -lower- insulin levels stored -more- fat than people with higher insulin levels, when both were continuously monitored. And he also says that dairy products and beef have been shown, at least in some cases, to cause a -greater- release of insulin than white bread. If this is true, even just under certain circumstances, this challenges some fundamental beliefs about insulin and the low-carb theory. Also he points out that, contrary to popular belief, insulin does not make you hungrier, but satisfied. Eating carbs is not a vicious cycle. It just so happens that it’s easy to eat a lot of carbs because they’re easy to digest and use as energy, compared to fat and protein. And the conventional wisdom of eating even just a bit of fat and protein with the carbs is enough to prevent a blood sugar burnout later. Macronutrients were meant to be mixed– this is verified by our tastes and traditions. No one is eating just plain bread.

(I am not a researcher– that’s why I mentioned Matt Stone, who references James Krieger. If you have issues with these claims, I thoroughly invite you to do another “smackdown”, if you can, similar to what you did with Anthony Colpo. Matt Stone has a big enough platform these days to be taken seriously. And I’m sorry to Matt Stone for putting him on the spot, but he should be held accountable if he’s going to say such things so definitively. I just figure the more discussion of these issues the better, as we can only get closer to the truth.)

Lastly, you brought up the “carbs like a drug” or “sugar like a drug” argument. Honestly, I don’t think our true feelings would lead us to drugs, which obviously alter our minds and health in negative ways (ways that carbs and sugar don’t). I suppose it’s plausible to be addicted to something, but you do realize what you are comparing it to. Carbs and sugar (fructose) are macronutrients. They’re food. Saying that we’re just greedy beings who don’t know any better for ourselves as applied to food is the same line of thinking behind the attacks on meat, saturated fat, and salt. You’re all quick to knock on our natural feelings because you’ve had to deny your own, and I’m sorry for that. We all want answers for our poor health, but I don’t think this is it. There are many other plausibilities out there if you look.

The receptors in the brain up regulate and down regulate to sugar, just like a drug.

As far as your comment about our true feeling wouldn’t lead us to drugs that represents a naive world view. I’m sure I tried all those alternatives you mentioned (I really don’t want to think about how many stupid things I tried when my world view was more like yours) and I regret all of them.

Feelings can and do lead us astray. Carbs and sugar do more damage than what people typically realize. As I’ve come to understand the science, and I take science classes (anatomy & physiology, biology, chemistry) when I have the time and money, I’ve lowered my carbs to zero and couldn’t be happier with the results.

I appreciate your candor regarding carbohydrate intake. And apologies should be given when others respond with sarcasm when everyone on here is simply trying to improve their health. In the spirit of this blog, you are indeed “betting your life on it.” I highly encourage you to continue your quest and to challenge what is being said to you. And be open to responses as well.

Please allow me to gently disagree with your idea that “carbs are not a vicious cycle.” You are absolutely correct that insulin is an anorexigenic signal (that is, it helps to increase satiety to decrease food intake). The way insulin does this is by binding to an insulin receptor which is located on the membrane of certain cells [including neurons]! In turn the insulin receptor sends signals to the brain to say, “Hey, you’ve eaten some carbs!” A receptor is a protein located on the surface of cells that binds (that is makes certain types of bonds with) a molecule called a ligand. Insulin is a ligand that binds to the insulin receptor. So, with a certain level of glucose, insulin binds to its receptor and that should tell you to stop eating.

However, excess carbohydrates alters this idea! You see, the excess chronic intake of carbohydrates causes the insulin levels to increase chronically! And this has a secondary effect on the insulin receptors. They do a funny little “shape change” and because of this shape change, they don’t respond to insulin quite so well! [We call this insulin resistance in the medical and scientific world.]

You are, no doubt, very familiar with this “shape change” to receptors. Have you ever noticed that when you walk into a room that smells, that after a few minutes you don’t notice the smell! That’s because the receptors change shape when they have been bound to by the smell molecules! They don’t work quite so well! [We say that they are down-regulated or “resistant.”]

This is what happens with those darn insulin receptors, they become resistant! And since they are responsible for telling your brain (along with some other important receptors) to stop eating, they don’t do it so well as before. So, you eat more! And if you eat more carbs (and man, OH MAN, do carbs taste good and yes they are so cheap!), then you make more insulin! And that makes the insulin receptors more resistant, which makes you eat more carbs, which makes more insulin, which makes the insulin receptors become resistant…. Well, you can see that right away you are in this weird cycle that keeps working against you. In science we call this a positive feedback (NOT to be confused with positive feedback from your boss which is a good thing!). Generally, positive feedback (in science terms) is not a good thing because it means that the condition continually gets worse.

So what can we do to interrupt this positive feedback cycle?? Reduce carbs!

And trust me, that’s easier said than done! But the thing is, when you restore those insulin receptors back to their non-resistant shape then they can give the proper signal to the brain to stop eating! And that helps!

And trust me, that’s easier said than done! But the thing is, when you restore those insulin receptors back to their non-resistant shape then they can give the proper signal to the brain to stop eating! And that helps!

I suggest that you give the diet a try and see for yourself that it can work. I began the Paleo Diet myself a year ago after my physician told me that my HDL cholesterol was down and my LDL cholesterol, total cholesterol and triglycerides was up. He was going to put me on a statin. Within 30 days my lipid profile completely reversed with HDL up and LDL, total cholesterol and triglycerides down. No statins for me! Plus, I am now 42 lbs less that I was at this time last year.

Yes this is the theory that repeated insulin spikes “wear out” the insulin response system. I don’t have a lot of good evidence, but I don’t believe it. Many people around the world eat large amounts of carbs their whole life without having this problem. If the development of insulin resistance were that simple, then why are there repeated reports from people on low-carb diets who have higher fasting blood sugar levels than before, indicating insulin resistance? (I’m not about to find the specific links but I will if anyone really wants to see them.) For all I know, insulin resistance is a mechanism induced by the body in order to store fat due to a low metabolism or some other hormonal dysfunction. And as Matt Stone says, sometimes beef (protein?) has been shown to spike insulin higher than white bread. So why wouldn’t that wear out the insulin system as well?

“Macronutrients were meant to be mixed– this is verified by our tastes and traditions”

I love this “logic”: The current average Western diet must be correct, because that is what everyone eats! Whatever everyone eats, must be correct, because everyone eats it!

Never mind that those same ‘tastes and traditions’ that everyone follows have led to probably the biggest epidemic of obesity and diabetes and other associated diseases in the entire history of humanity.

There were two parts to that statement– one of which is “tastes”, which, while not anywhere near proof, I argue deserves to be considered. The other part is “tradition”, which is a little more compelling. Again I ask, since when has tradition been low-carb? Aside from a few stray examples such as the Inuit, and what we may or may not assume about our paleo ancestors, I cannot think of a single significant culture that is traditionally low-carb; and this includes the cultures that Weston A. Price visited, if you read closely, which are the cultures that were upheld as some of the healthiest in the world.

Well, I happened to come across some startling information in the 2004 USDA report “Nutrient Content of the U.S. Food Supply, 1909-2000”, and I’ve linked to some graphs below if you don’t believe me. It turns out that, if we are to believe this data, the average consumption of potatoes has about HALVED since the start of last century (1), and grain consumption, including wheat and corn, has reduced by about 30% (at one point, 1972, being about HALF of that in 1909) (2). Even if you were to give the most generous margin for error in these statistics, the general trend has been a steady FALL in high-GI carbs during the century, especially during the time which heart disease became a national issue.

Now, what is true is that consumption of sugars has steadily risen throughout the century (2). Even though personally I don’t think fructose (1/2 of sugar) is harmful, I would back down if Dr. Eades would shift his focus to only fructose, as there is reasonable evidence for it as a culprit. But Eades claims that all carbs, any carbs, are a problem if they contribute to blood glucose (1/2 of sugar is glucose, and about 1/2 of fructose is converted to it, according to some sources). And yet, even INCLUDING all sugars and sweeteners in the count, the AVERAGE AMOUNT OF CARBS CONSUMED DURING THE 20th CENTURY DID NOT RISE. It actually DIPS during the years 1951 to 1986 (3).

So while it’s true that the total glucose load has risen significantly since 1986, there was apparently no more a total glucose load in 2000 than there was from about 1909 to 1930. If insulin’s the problem, then how was this golden age of almost no obesity or diabetes in 1920s New York City possible?

Perhaps you might answer less calories (due to less unsaturated fat, actually) and exercise, which is fine. What I have a problem with here is the scare over insulin. Dr. Eades once said, “I can’t imagine a person who I wouldn’t recommend a low-carb diet to.” The resounding message is that carbs are completely unnecessary, and our ancestors probably ate next to none of them. The result is that people are led to believe that a very low-carb or even no-carb diet is the healthiest one, regardless if one is overweight or not; whereas it is actually a modern deviance that in many cases results in poor health. I’ve heard horror stories of parents trying to “save” their poor teen from a horrible insulin-resistant fate by filling their oatmeal with rancid fiberous almond meal. The fear of glucose needs to stop. Dr. Eades– You, Gary Taubes, and Barry Groves are largely responsible for it.

(Not sure why the last pic isn’t working. If you really want to see it, just go to the site I opened, http://tempwebs.webs.com, and click on photo gallery. Or see pg 18 (28 of pdf) in the report I linked to.)

I am studying for a masters in nutrition and am fascinated by your work and the science based approach you use. I have a burning question for you – granted I have not yet read your book but I hve ordered it, so prematurely………what about fiber?! I concur with the not eating of grains, i concur with the paleo view, however in order to get enough fiber each day I pile my plate with veggies (carbs) and have some fruits during the day. What do you think? I would find it hard to believe that you dont think fiber and phytonutrients are crucial? Thanks!!

Actually, there is no real need for fiber. It was all the rage for a while, but newer studies have shown that fiber does very little, if anything, to modify any kind of risk factors. I wrote a post on the mechanism of fiber action that you may be interested in reading.

Dr. Eades,
I can attest to the antecdotal evidence of fiber doing “little.” As I have posted a few times here before, I went totally carnivorous (as an experiment) over 2 years ago. And my assessment of my energy, overall health, and improved physical stamina, have kept me on my “experiment”!!

After a short period of adaptation to no fiber, wrt bowel movements, all is very well! Little to no flatulance, smaller softer, no lower intestinal discomfort AT ALL….EVER, and an overall general comfort within my body.

Over these last 2 years or so, I have a few times (very special occasions, indulged in a few green vegatables, grains, etc. and each time came bloating and gas, and a return to a feeling that, “this just isn’t right” .

Thanks again for all you do in lengthening people’s lives, and enhancing those later years via improved health!
Sincerely,
George
Your 42 yo male carnivore!! 🙂

Geo,
Could you please elaborate on what foods you eat and you do not? I do notice that after a few days eating mainly eggs & cheese and zero fiber, my intestinal transit is not as “regular” (as it is when I eat tuna+egg+avocado+fresh tomato, for instance). Anyway, could you please give us more info on what plan you are following at the moment?
Thanks!
JLMA

Speaking of comics: I turned up an old Hagar the Horrible strip last night. Hagar’s doctor has told him he should drink water instead of beer, and eat vegetables and salads instead of fatty foods. Hagar’s friend says, “Wow! What did you do?” Hagar replies, “I switched doctors.”

Isn’t the role of epidemiological studies to generate hypotheses which must then be tested through intervention studies? Haven’t we intervened already by telling people to eat less animal fat and less cholesterol for the last 30 years? So when do we acknowledge the results of this intervention, i.e. the current obesity epidemic?

We’ve all been unwitting subjects in a long observational study, the hypothesis of which is that a low-fat, high-carb diet will reduce obesity, diabetes, and the other so-called diseases of civilization. In my view, it hasn’t worked out all that well.

T. Colin Campbell would respond that the failure lies in the fact that Americans aren’t actually eating a low-fat diet. In his worldview, a low-fat diet means only 10-12% of calories as fat, and Americans currently eat something like 30% of their calories as fat. Personally, I don’t even want to think of the constant gnawing hunger and metabolic nightmare I’d suffer with a diet that high in carbs.

I assume what you find disagreeable is the statement that the brakes were pushed on instead of stepped on? You steer a plane on the ground using the rudder pedals. You always have your feet on the rudders both while on the ground and while in flight. You push on the tops of both rudders to brake the plane. So, unlike in a car, where you move your foot from the accelerator and step on the brake pedal, in a plane your feet are always on the rudders and you simply push on them to brake.

And don’t forget to have your feet on the lower part of the rudder pedals when landing… I’ve watched some interesting student landings when they had the brakes on while touching down. (Having one brake on can be a serious situation)

BTW my best friend is an airline pilot who is due to retire soon. He has his eye on a Cirrus also. I’m still a 172 guy. Got a Garmin G1000 glass cockpit. Sweet.

re: cinnamon
Received bottle of cinnamon capsules yesterday (http://www.greenbush.net/). Took 2 last night. At 7:50 am, before eating/drikinng anything, the Prestige device reported blood sugar at 75. It is normally 80-95 when I first get up and then goes down to @75 within 1-2 hours. Only the first day so can’t “conclude” anything but interesting nonetheless.

When I started working in a lab in 1980, upper limit of our reference range for cholesterol was 280 for females and 300 for males.
Ahh, looking back, boy I miss the SMAC – what a fun instrument to run!

Was listening to the live stream of the conference on saturated fats. The guy (Hayes?) who was speaking around 3pm EST seemed to be going to great lengths to say that saturated fat in the diet isn’t a problem if you have enough polyunsaturated fat to balance it. He was talking about a 1:1 ratio as optimal, if I understood him correctly. He was basing his conclusions, from what I could gather, on how the ratio affects ldl/hdl ratio. Have to admit, though, that he was using a lot of terminology that I really didn’t understand very well.

One of your commenters, Grace, implies that Nathan Pritkin’s cancer – leukemia – was caused by his diet’s “blatant lack of saturated fat and the fat-soluble antioxidants which are ONLY found in fatty ancestral foods (CoQ10, vitamin ADEK2, lipoic acid, carnitine, potent carotenoids, etc). ” You correct his mistaken reference to Ornish, but you make no mention of the fact that he – Pritikin – lived with leukemia for 27 years and that, in all probability, radiation treatments he received as a young man for a skin conditon were its likely cause.

We don’t know that the radiation treatments caused his leukemia. They could have or it could have been any number of other factors. Many people get leukemia without ever having had radiation treatments in childhood. The truth is that we don’t know what caused his leukemia. I do know that – at least in primate experiments and from my own experience with patients – extremely low-fat diets can lead to profound depression. Most people don’t kill themselves unless they are depressed.

There is the crux of the matter. Either you believe carbs is food or you believe carbs is not food for humans. If you do, then all your arguments will tend to favor continuing to eat carbs regardless of the facts opposing this.

That is the fundamental principle Gary Taubes attacked in his book, although not in those precise words. I mean, why would food make us fat, sick, weak and probably stupid? Food doesn’t do that for pretty much every other species on this planet. No, food keeps them in perfect health indefinitely. Why not humans? Well, maybe what we eat isn’t actually food. Considering the current obesity (and heart disease, diabetes and cancer) epidemic, that looks about right.

At the moment I am betting my life, as you say. I’ve repeated this story so many times on various blogs I’m tired of reading it myself. I was healthy, fairly low triglycerides (87) HDL 65 and LDL 109, healthy and very fit, exercised regularly, never had a weight problem. I had a heart attack anyway last year…I am 53. My father died after his third at 65.
I was given a statin (40 mg simvastatin) after the heart attack and was on more or less an AMA style diet. I thought that wasn’t so great and switched, cutting out some of the crap they allowed. Still low fat. My blood work was ok but not to my liking. HDL 40 ! LDL was low…like 63 and TG 67. I wasn’t thrilled.
I altered my diet again and upped the brown rice, beans, quinoa but cut out all wheat and sugar. (I hadn’t been eating “any”…”none” refined or processed crap in months). Added “some saturated fat.” raw milk, grass fed beef, not a lot of fat but more than before. Last labs, HDL 46, LDL 74, Triglycerides 43. Getting better but I want more. This is my third week since cutting out the rice and quinoa and only eating carbs in the form of veggies and some fruit (not much) and a sweet potato at dinner. I upped the fat (full fat greek yogurt), more coconut oil
( I cook with it and 2 tbsp per day in salad), grass fed ground beef daily instead of once per week, skin on chicken etc. I see the cardiologist in December (another stress test also). I am telling him I want to come off the statin. Maybe switch to niacin? But I don’t, nor have I ever, had cholesterol problems. I’m hoping my next labs in December will be on the mark. Yes, I’m taking the big gamble. Betting my life I guess.
To most it seems strange. You had a heart attack? So what do you do now? “Well, I increased my saturated fat intake.” lol

you might want to get a VAP test – your labs look like mine (I also have had two MIs). The VAP should let you know if your LDL is small/dense (atherogenic) instead of big and fluffy – you want big and fluffy.

Indeed, there is no proof that exposure to radiation causes leukemia. So, we should conclude that the far more unlikely cause of Pritikin’s leukemia was his diet, a diet which resulted in – if his autopsy results are to be believed – a vascular system as free of plaque as a teenager’s. Fortunately, HIS autopsy results have been released by his wife.

And his depression? Of course, enduring the painful recurrence of his leukemia would have in no way caused his depression. Diet induced, right? That darned Pritikin diet again …..

The words you’re reading on Gary’s blog are not Latin. He hasn’t posted anything yet and is just getting his website together. The “Lorem ipsum dolor…” that you see is the standard place holder text for a piece that doesn’t have the real text. It is used so the person designing the site can see what it will look like when it does have real text in it.

I’m pretty sure I remember when that magazine came out. And I felt as sad as the bacon and egg face. It still makes me mad when I think about how many bowls of oatmeal I consumed in the name of health.

I followed the link to the Taubes interview. Interesting, although I do think he is way off base when he says that until 50 years ago, the Japanese ate brown rice instead of white. Where did he get that information?

The founder of Prevention, whose name was Rodale, I believe, ate ‘healthy foods,’ etc., and keeled over with a heart attack in his 60s. He bet his life, probably had a good life and died just the same way many people die – despite all of their best-laid plans.

I read a very entertaining letter in a medical journal from years ago.The author, a doctor, had listened to all the quibbling and arguing about cholesterol and carbs and fats and he said: ‘What are you going to do? Faithfully follow some regimen, racking up all the points you can in debates about why you’re right, and then what? Let’s say that almost by chance (you happen to fall in the statistical group the diet DOES work for), you don’t die of a heart attack. You’ll die of cancer, then. That is, assuming you don’t die from injuries suffered in an accident. Happy, now? You got the go-ahead to die from cancer. Oh, good. Wait, you say you’re not going to die from ANYTHING? Oh, that’s even better – you won’t die, then. That’s just about the best…’

Well, good luck with that.

Believe it or not, dying quietly in your sleep when the good Lord has decided it’s your time used to be thought of as one of the better options.

Can’t believe people stuff themselves with fat and chew on meat, passing up healthy vegetables, sneaking in birthday cake, keeping score, actually believing they are going to beat the odds and live until they time they decide they are going to call it quits.

How is chewing on vegetables “healthier” than chewing on meat and fat?

You may be conflating two variables: how long one lives and the quality of one’s life. What if the good Lord wants you to live until your 95? Does He want you to suffer up to that age or live as healthily as possible up to that age?

This is what I tell friends all the time–we will all die from something. Something will always be the “number one killer” and if we knock that monster from its perch then another one will take its place. Already I’ve heard doctors refer to Alzheimer’s as “the new heart disease,” because people who would have died, say in their 60s or 70s from heart disease are now living longer due to medical interventions, and instead die of Alzheimer’s in their 80s or 90s.

Very entertaining and educational.As said; We live in a crazy time in a completely idiotic world.
Why are there no invaders from outer space who will pick us? Us who can think clearly and see the truth in the eye?

Dr. Eades – As a heart attack survivor at age 50 (and a second one a month ago due to blocked 8 year old stent) who has low traditional risk factors (never smoked, ideal weight, no family history, no hypertension, and genererally good lipid labs) I’m naturally interested in various diet claims for prevention. I’ve read Atkins, Ornish, Pritikin, and just got a copy of Dr. Claude Esselstyn’s (Cleveland Clinic) book which is similar to Ornish except that unlike Ornish he won’t even allow nonfat dairy or egg whites. Esselstyn’s book came just as I was winding up reading Gary Taubes intriguing GCBC, reading Denise Minger’s thought provoking critique of Colin Campbell’s China Study analysis, and watched Taubes’ discussion with Ornish (and Oz) on You Tube. Like Ornish, Esselstyn does seem to have some very powerful clinical evidence (as opposed to lab values). Not merely the angiographic “coronary plaque reversal” which both claim to have achieved in their patients after 1 and 5 years, but also. like Ornish – the (seemingly) very impressive cardiac PET scans which show almost immediate and dramatic improvements in blood flow after only weeks on their extremely low fat diets, as well as dramatic immediate improvement in endothelial function as measured by brachial ultrasound and ankle pulse volume. Esselstyn provides the before- and -after PET scans and pulse volume graphs in his book 2007 book “Prevent and Reverse Heart Disease”. Moreover, he says his cohort of initially severely ill patients whom he says he has followed very closely for twenty years (this guy really does seem to be incredibly devoted to his patients’ care) have with one exception, he says, not only survived but show no signs of angina or repeat coronary events and are in excellent health. The exception involved a patient who had had massive scarring and died from arrhythmias. He says he has published the results. Although low carb proponents claim good lab values (and great weight loss), I’m frankly less interested in lab values (or weight loss) since my weight is ideal (5’9″, 153 pounds) and my labs over the last 8 years have generally been quite good and apparently didn’t help – eg HDL’s well above 50, sometimes into the 70s, LDLs in the 80-90 range (although my recent VAP showed predominant subtype B), apoB100=75, most recent TGL= 76 , (taken on Ornish food with a few nuts!), Lp(a)=6 and total C around 165. No, rather than “nice labs” those of us with heart disease are more interested in whether a diet will actually improve cardiac blood flow and endothelial function – as these guys so prominently claim. So I was amazed when I saw Taubes/Ornish/Oz that Gary Taubes did not question Ornish’s PET scans, which Ornish repeatedly held up as proof. Do you really think Ornish and Esselstyn are making this stuff up? Are they overstating their significance? Like angiography, are PET scans subjective (although I note Esselstyn says he used blinded techniques with his study angiograms to avoid bias)? I was surprised to see in a previous blog thread that you mentioned you weren’t familiar with Esselstyn who seems to be fairly prominent in this debate. Isn’t cardiac blood flow and endothelial function the real bottom line? As a cardiac patient, I have no agenda and would appreciate it if the two sides would stop sniping and would help patients in discovering what we know or don’t know. I find it very hard to dismiss somebody who demonstrates proof of vastly improved blood flow after only a month on their diet – BUT, I do remain open minded.

You’ve raised an issue that is too complex to deal with as an answer to a comment. You can search ‘Ornish’ in this blog’s search function and see what I’ve written on the subject already. You can take a look at this post to see how information is distorted. Ornish’s co-author on the PET scan paper has basically ditched the ultra-low-fat diet and has written a book recommending a high protein diet.

thanks for taking the time to reply – read your referenced post on the variability of brachial artery reactivity testing – which isn’t PET scanning. The issue seems simple to me – check PET scans on people following various diets after a few months to see the results on blood flow. Supposedly (according to Drs. Ornish, Esselstyne, K. Lance Gould etc) these blood flow changes seen on PET are rapid and dramatic on low fat/complex carb diets – mere weeks, not months or years. Unless PET scans are as subjective as angiographs (which seems hard to believe).

Wondering if this machine was as good as its restaurant counterparts or just another overpriced toy, we followed the simple setup instructions and cooked fish, chicken, and steaks — all with perfect results.

Way to go Drs Mike and Mary Dan!! In honor of that review, I’m cooking our NY Strips in the SVS tonight. (Of course, I was going to do that anyway… but we’ll tip a cut of perfectly cooked steak to you both!)

Dr Eades,
Thanks for keeping up this blog.
I have read several of your books (and given away many copies of Protein Power). Been following low-carb for 10 yrs now, since I first found Protein Power in the White Hall Arkansas library, and said to my wife, “Hey, this is written by some one from Arkansas!”

I will admit that I don’t always keep the straight and narrow (Sourdough Pretzels are my downfall) but I have managed to keep my weight down and waist in check for 10 years and feel much much better than BPP (Before Protein Power).

Anyway, your blog is an encouragement to me to keep fighting the good fight. Appreciate all you and Mary Dan do for us.
Mike in Arkansas

Rob, great job with this article as always! I love reading your posts. I’ve marked this as a favorite and will be sending my crowd over to read. I see the misinformation about cholesterol on a regular basis with personal training clients who are afraid of eating more “fat” because they’ve been brainwashed into thinking it’s the root of the problem.

Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.
By David H. Freedman

Bottom line, you do what makes you feel better physically and mentally. I can only speak for myself, but I have never felt better in my life following what I like to call LCL, (low carb living. I don’t like using the term “diet” because it has been misused and abused as a mere short term fads.)
Everything from my temperment, to my energy levels have improved considerably. I eat less, because satiety is achieved. I have always flossed, but now I find my gumes never bleed, ever. I also find that I don’t need as much sleep as much as I used to. I love working out and I am finally getting the results I have always wanted.
We never do know what the future holds , but one thing we do know is how we feel right now., and bottom line, thanks to Dr’s Eades, Fred Hahns and others in the know, I feel fantastic!

Thank you so much for posting on this topic. As a medical student, I am constantly bombarded with everything that goes against my low carb lifestyle. I really do feel like I am making a big gamble when I sit through a nutrition or cardiovascular lecture. I mention it to fellows students only to hear “oh, I just read an article in a national newspaper that eating low carb harms your brain.” Or, but “ketosis is really dangerous.”

Just wanted to let you know that The Atlantic has an interesting new article called “Lies, damned lies, and medical science”

“Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.”

While I understand reasonably well (I think) Eades’s and Taubes’s arguments concerning cholesterol, I had a blood test that returned some strange results. Total cholesterol: 593; triglycerides 53.4; HDL 105; LDL 448. As a 28 year old, this seems completely bizarre. To make sure I wasn’t living in fantasy land, I had the test repeated and achieved the same result. Of course, Herr Dr. wants to immediately use statins and I want to immediately reject that idea. Is there something else out I there I should consider (tests, etc), while I’m arguing with my Dr. about how to deal with this issue? Mild hypercholesterolemia runs in one side of my family, but not the other. I’m thin, no diseases (besides allergies). The coup de grace here is that I’m an expat living in CZ, so communication is a pain in the ass.

Who knows Ben. Maybe you’re suffering from a statin deficiency that must be remedied asap. But seriously, if you are in good health, then a blood test should show just that. Rather, whatever a blood test shows when you are in good health should be viewed as an indicator of this good health. Then again, were you in good health at the very moment blood was drawn from your vein?

But health is measured in the blood. No, it’s not. A blood test will only reveal the reason for a disease if disease there is. But why even draw blood if there is no disease? Ah but for the prevention of disease. Fat lot of good that did us for the past 30 years huh.

Check to see in what units your TC is being reported. I bet that’s what’s wrong. DON’T DON’T DON’T be seduced into taking statins without all the relevant data, and even then be really, really cautious – especially if you’re even a moderately heavy exerciser.

The TC should be reported in the same units as are HDL & TG, namely “mg/dL” (milligrams per deciliter).

If the units don’t all agree it’s impossible to calculate LDL. You’ll end up with your current bizarre figure, although I calculate “your” LDL as 477 mg/dL, not 448!

Reply back when you get it straightened out. I really would like to know.

I have a similar question as Ben. I have responded well to going low-carb (Primal Blueprint) with blood sugars at great levels, cholesterol ratios excellent. My husband on the otherhand has not responded as quickly. We’ve been “primal” for 4.5 months now. He had been on statins in the past due to having high cholesterol at age 28 (now 38). his family history contains both grandfathers dying of heat attack or enlarged heart, uncles on both sides of the family having heart attacks and his own father struggleing with high blood pressure and high cholesterol. We had done the low-fat, whole grain diet for years hoping to avoid statins, but no luck. Thankfully we discovered the low carb, high fat diet. My husband and i have lost about 9-10 lbs each. My husband has about 7 – 10 lbs to go. So 4.5 months ago, my husband quit the statins and started the low-carb lifestyle. We were hoping for better ratios than what his VAP test revealed. he has Pattern B LDL. all his ratios are higher than what is recommended. his TG are still at 99 and hdl, 55 despite being very lowcarb/high fat. His fasting blood sugar is 99. He consistently has 10-20 pts higher postprandial blood sugars than I do. I guess this goes along with being pattern b and I am pattern A. So my question is do we need to give this more time for the HDL to get higher to get rid of the VLDL….and if so how much time. The idea of betting his life is emotionally scary for me. he is the love of my life and we have three young sons. I am not in a betting mood when it come to having him around. with his family history, do we need to approach this differently or keep on going with the low carb/high sat fat diet? Thanks for any imput.

I really can’t give medical advice over the internet. I would have to have much more information than you’ve provided to make any kind of judgment, and even then couldn’t do it without an examination. Your husband needs to find a good physician versed in the higher-fat, low-carb diet (these docs are more common now than in the past) and work with him/her to deal with these issues.

In general terms, what is you advice to people who lose weight on a low-carb diet and reach their goal weight, but have a substantial increase in LDL on their fasting lipid panel. Should this be ignored? Should more detailed lipid analysis be performed?

I say “great!” your LDL particle sizes are now bigger and less dangerous. Your LDL counts haven’t risen, it just looks bigger.

The Friedwald is an inexact formula based on what are considered “normal” dietary behaviors. Removing most fructose from the diet nearly eliminates the small, dangerous LDL particles Dr. Krausse has discovered (as well as inflamamtory pressures) which are made via liver produced VLDLs that steal APO-B100’s from your HDL, making HDL drop.

I would like to see more studies besides “The Iranian Study” on true LDL counts when fasting triglycerides are low. Actually I’d like to see the Friedwald scrapped altogether. The fact that billions of dollars of drugs are prescribed annually based on “estimates” drives me batty. I’m affraid the stress will kill me *grin*

Could you please advise how I can locate a good physician in Australia who is versed in the higher-fat low-carb diet – specifically as it relates to blood test results? Failing that, I would be happy to make an appointment with you, or anyone you would care to recommend, in the U.S.

I agree that the Pattern B LDL is troubling, but are you sure that all the readings are as bad as you think they are? Here are the “Normal Values” given me last month at a Baylor medical center (in TX): TC 40, LDL < 100, TG < 150, and Glucose < 100 fasting or < 140 non-fasting. ("” is greater than)

Now let me give you a couple of quotes from Dr William Castelli, a former director of the Framingham Heart Study project and a dedicated believer in low fat diets.
Interpreting Test Results – per Dr Castelli (Sept 1990 interview)
If “total cholesterol (TC) is between 150 and 200,” HDL must be taken into account.
“Your TC divided by your HDL should be under 4.5. The ideal ratio is under 3.5.”
If “TC is between 200 and 240, the TC/HDL ratio predicts your risk of heart disease 3-4 times better than LDL and 5-6 times better than total cholesterol.”
”If your TC is over 240, LDL is a better predictor, because few people have enough HDL to bail them out of a higher LDL.”
“However you will find the rare person who has a total cholesterol of 300 and a high HDL, say 100.” [That’s me] “… this guy will go to his doctor’s funeral …”

What I’m trying to show you is that even this eminent high-diet-cholesterol-means-high-serum-cholesterol doctor isn’t saying, If your TC is over 190, or your LDL over 150, it’s curtains for you. I think the “Risk Ratio” he refers to is becoming more widely used. Baylor says, “Less than 4.5 to prevent progression [of cholesterol deposits]; Less than 3.5 to induce regression,” which is what Castelli said.

Remember that no one knows exactly what our readings mean. It sounds as if you’ve both made good progress, but your husband still has further to go than you. It is 4 months since you posted and I hope there has been more improvement in your husband’s readings. I hope, too, that you and your husband are in an exercise program – however modest. Three young boys can join you in this. Maybe your husband could walk for a 20 minute circuit (minimum), then you and the troops on tricycle, bicycle & stroller can join up for another 20 min or so. Exercise is good for your HDL, resistance better than aerobic, but exercise in a planned, sustained way, not biting off more than you can chew but allowing yourself to do more as it becomes easier.

Interesting information. I was wondering why, on my last lab report (Dec, 1, 2010) my doctor had my TC circled in pen but did not call me to discuss it. BTW, I get copies of my lab test mailed to me for my records. My numbers were:

TC: 213, LDL: 114, HDL: 62, TGs: 181.

Given these numbers my TC/HDL ratio is 3.4 and my LDL/HDL ratio is 1.8. So according to Castelli my CHD risk is low?

I’m eating fewer carbs and cut out my daily wine to lower my TGs but what has made me shy away from a low-carb diet like Atkins or Protein Power is my uric acid levels which were 8.7 and my serum ferritin which was at the upper limit of normal.

Comments?
p.s. hopefully I’ve converted the numbers correctly. In Canada we measure lipids in mmol/L and umol/L for urate. I used an on-line converter.

It’s important to note, for those who will protest (and may already have, there are too many comments and I don’t want to wade through them right this minute), that just because you say the low-carb, high-fat approach is the correct human diet does not mean everyone has to eat the exact same foods. When we speak of diet we may be speaking of specific foods and habits or we may be speaking of macro- or micro-nutrient composition and proportion, and clearly you’re speaking of the latter. There are so many ways to low-carb, so many possible food combinations you could pursue, that that one low-carb diet actually translates into a hundred or more different diets.

So there’s room at the table for everybody. Let’s not lose sight of that and pursue something with an unhealthy macronutrient composition just because we’re allergic to beef, for instance, or must keep kosher or halal.

Speaking of which. Pardon my soapbox for a minute…

I think “crusade” would be a better descriptor of our culture’s war against cholesterol than “jihad.” First off, the Islamohatred in this country is getting way out of hand so it’s kind of not cool to use language that furthers it, even unintentionally. I was a member of a certain minority religion for years (and I know a low-carb cookbook author and her husband who still are now, by the way, and you’ve met them) which was targeted by a majority religion and I can say with some authority and bitter experience that Christians can be just as nasty as Muslims when it comes to religious intolerance. More so, in fact, since there are more of them in this country, they have committed far more terrorist attacks (going by number of attacks) on American soil–including against American Indians–and they perceive themselves as being on the “right” side of American history.

But more to the point, it makes more linguistic and historical sense to call this a crusade. Jihad at least sometimes has the connotation of striving to better yourself, of right winning out over wrong–and sometimes Muslims have been successful at this in their own lives and cultures. Witness their Golden Age in which they furthered mathematics and science and saved Greco-Roman knowledge from being swallowed up in Europe’s Dark Ages. Examine the history of the Iberian Peninsula for more examples. But “crusade” has the linguistic and historical connotation of a lost cause, which is what our war against cholesterol has been.

It’s easy to use words–and misuse them–without thinking. And I’m aware that currently, self-described Muslims have been guilty of some heinous behavior, both here and abroad. But misusing language in the act of throwing out a cheap metaphor isn’t going to solve that problem. If anything, it intensifies it.

Perhaps that’s your interpretation of ‘jihad,’ but it’s not the Oxford English Dictionary’s, which is my gold standard for word usage. If you look up crusade in the OED, you go all the way down to the 5th definition before you find “A vigorous movement or enterprise against poverty or similar social evil.” The previous four definitions all have something to do with Christians warring against the Muslims. Looking up ‘jihad,’ you find the 2nd definition to be “a campaign or crusade in some cause.” Despite the former word’s being used in the definition of the latter, I think the latter is the more appropriate word when used in the context of a campaign in some cause, which, in the manner in which I use the word, is the movement to decrease fat in the diet. We all know that the right fat in the diet is a good thing, and not a social evil, which makes ‘crusade,’ as defined by the OED, less apropos in the context in which I used it than ‘jihad.’

Actually, I think the OP is exactly right, as Crusade carries the connotation of a moral reform movement (think of the history of the Crusades, including some of the more scandalous, failed ones) which is exactly what the “War on Fat/Cholesterol” comes down to in North America.

And jihad does imply a spiritual and personal battle. Maybe it didn’t (in English) 20 years ago, but it does today.

My goodness Dana, what is the color of the sky in that world of yours? I know this is not the forum for religious or political discussion but since you apparently do not know this, I thought I’d address and ask you a few questions. Being a trained historian and not a medical doctor I am very interested to know more about that country where “Christians are the majority” that “terrorist attacks” are being perpetrated. I mean in this day too, not 100 some odd years ago. Also, I wonder if you realize that Islam finds the word “crusade” offensive. Jihad or to to be called a “jihadist” is actually a compliment to faithful Muslim.

“European Dark Ages”? You must be taking about that time when scientific foundations were laid, universities were invented, humane and fair law was finally codified, Byzantium flourished as the greatest city on the earth.
As for your “golden age”, historian David Bentley Hart informs us that ” Islam was the beneficiary of Eastern Christendom.” It was “Syriac-speaking Christians who provided an invaluable caste of scholars and physicians, and through them the achievements of Greek and Roman antiquity passed into Islamic culture.” In fact, not Moorish Spain but medieval Italy was “perhaps a more important port of entry for Greek texts into Western Europe…in the late eleventh century”

Would you like to speak of tolerance? In Islamic nations, every minority has been oppressed, harassed, pushed to convert, or leave. This is historical fact, not something invented or made up in the historically revised modern American public school text book.

I come to Dr Eades blog, as I’m sure you do, for medical facts and understanding, not manipulated statistical data and I certainly don’t want manipulated historical revisionism either. As a historian I won’t settle for it, nor allow for it to be said unchallenged. With all thy getting, get understanding.

Concerning Pritikin: I worked with him in the 70s and 80s as the cardiologist and later medical director at the California Pritikin Longevity Center. He developed leukemia long before he began a low-fat diet. Interestingly, the leukemia was totally asymptomatic and in remission for over 20 years when he reluctantly saw a hematologist at UCLA. The hematologist was certain that Pritikin had hairy cell leukemia and that chemotherapy was indicated. Pritikin was convinced to take chemotherapy although it contradicted everything he believed and stood for. He had an extremely adverse reaction to the chemotherapeutic agent that included liver and kidney damage. He was quite thin to begin with and following the chemotherapy he lost about 30 pounds and appeared cadaveric. Pritikin traveled from California to a hospital in New York state under an assumed name for a second opinion. He was told that there was no hope and that he would most likely die quite soon. He said goodbye to his family and sent them out to eat dinner. He then severed both his brachial arteries with a scalpel and bled to death in his hospital bed. His autopsy was subsequently reported in the New England Journal (1985 Jul 4;313(1):52).
His coronary arteries were perfectly clean despite his having had significant (and convincing to me, a pretty good clinical cardiologist) angina in the days before routine coronary angiography. Pritikin developed his diet initially to treat himself. His angina went away early on as he became a low-fat vegetarian. For all apparent purposes his diet served him well.

I know it’s old news for the US but the KFC Double Down has recently come to Canada, and I read the following article in the Globe and Mail that makes me so annoyed… that I posted the link here just to get it out of my system! (I’m generally a lurker but I couldn’t take it any more.)

Two years ago I had my serum lipids performed. Note this was on an ultra high fat paleo diet.

TC: 7.7 297
HDL: 5.5 213
LDL: 2.2 84
Tri: 0.8 71

The GP looked at the results and told me gravely that I had one of the highest levels of TC he had ever seen and was very concerned. I almost laughed. How can a HDL: LDL ratio of 2.5:1 and a triglycerides level half the recommended level possibly be bad?

The GP then gave me a diet sheet that recommended a low fat . I politely explained that I had 20 experience as a food scientist and didn’t need a low fat eating guide.

esselstyn claims 100% of his patients who had such advanced heart disease they were thought to have a year to live all lived longer than 20 years and were still alive when he published his book… he also says he didn’t encourage them to exercise, unlike ornish.

this leads me to a couple of questions: if this is the case, how can the vegan high carb low fat approach be bad, or rather, how can it not be considered the only approach proven to reverse and/or prevent heart disease?

the other is, when are we going to have an equivalent for the low carb approach, that doesn’t rely on risk factor modification and actually scans arteries both in patients with and without heart disease?

my feeling is that risk factors are a really weak indicator of actual heart health, and are very easily manipulated by short term changes in diet.

It’s obvious that by the standard metrics used that the low carb approach is superior, but i feel like it’s entirely possible the standard metrics we use to gauge the health of a diet at this point aren’t that meaningful.

the ornishes and the esselstyns are totally convinced that even almonds and olive oil are atherogenic, describe plausible methods by which they are, purport to have the direct clinical experience with heart patients, and esselstyn is the head of surgery at the cleaveland clinic.

combined with the actual before and after results of reducing plaque and opening arteries… how do i know what to believe?

i would LOVE to be convinced of low carbs superiority in heart attack prevention as its the right diet for my preferences… but i feel like i need to see hard results and not just risk factor changes.

dr mike, it would be much appreciated and useful if you would be willing to do a blog post debunking of Esselstyn’s book/work from your perspective.. i did read what you had to say about ornish (that his study didnt separate between exercise/meditation/smoking cessation and diet alone) and found it to be a reasonable/helpful conclusion.

Dr Eades,
After I read Nov 9th Dopey Joe’s post I thought you’d address his questions and comments in a more in-depth way. Would this be possible? I think many of us would like to know what you think on this. Thank you,
JLMA

I’ve addressed these same issues a thousand times in the pages of this blog. All you have to do is look for it. I figured anyone who reads this blog regularly would know my stance on this issue, so why go through it all again?

Is it really plaque that you’re after, or all-cause mortality? Because the low-carb diet does very well in studies that measure whether or not you’re actually alive as the endpoint. This blog and GCBC is full of references to such studies. When you’re interested in whether you’re going to die or not, the plaque is as much a secondary metric as your cholesterol levels. Just a thought.

Is this really an accurate way to think about it… that plaque is as much as a secondary metric as your cholesterol levels?

I thought plaque in itself was considered serious/dangerous/life threatening in that it continues to accumulate and can burst, where cholesterol is much more murky and possibly meaningless in most cases.

I have been researching nutrition for many years and have found the low carb approach to be very helpful, though my emphasis tends to fall more on the side of eating larger quantities of veggies than of meat. I read the benefits of eating more meat, but don’t feel the benefits when I consume it (i.e. it makes me feel very heavy for a few hours after eating). So I struggle with the following…how can it be healthful to eat a large quantity of something that doesn’t contain its own enzymes for digestion? AND If we all subscribed to this diet, how could we possible raise enough meat with the high demands that “sustainable” farming has on the land? It doesn’t seem like a very holistic approach when considering that its not realistically supported by nature. Would love to hear any and all thoughts about this.

Any thoughts on high LDL & total cholesterol levels having anything to do with hormones? I am a 28-y-o female whose doctor mistakenly had her cholesterol checked (on a routine blood test); it came back Total 263, Trigs 32, HDL 79, LDL 178 (calculated, apparently). My naturopath thinks it might be something to do with hormones (other than thyroid I suppose since my TSH was 1.18). I don’t know what to think of it?

(I’m not low carb yet but even so my diet has been whole-foods-and-grain-free-only for 3-4 years.)

It’s hard to say without having more info, but I doubt that your hormones are responsible for your various cholesterol readings. What I do know is that an HDL of 79 and triglycerides of 32 are looking pretty good.

I am persuaded that cholesterol is a good thing and completely misunderstood in popular medicine as practiced today. I enjoy low carb eating and practice much of your advice. Briefly my experience:

In 1984 I wasn’t knowledgeable of, nor eating, a low carb diet–but my cholesterol was 120 and I felt smugly confident. For the past nine years I have been eating a low carb diet and am again feeling smugly confident–even though my cholesterol is now 380+. (Note: during this time all my blood tests showed CL component parts with preferred ratios and molecular sizing, even though total levels varied as reported)

My doctors initially freaked out about my total cholesterol levels and wanted to force me onto statins, but I didn’t let them. Eventually I underwent carotid artery sonograms in order to discover if my arterial plaque was dangerously high, as they predicted and feared it would be: they tested me twice, because they didn’t believe the first results–0% plaque on both sides. I’m happily not and never will be on statins.

I don’t know if my low-carb diet reversed any plaque or if I never had it to begin with–I do know that doctors report arterial plaque deposits average between 40 to 60% occlusion for people my age–and my doctors are still at a loss for my arterial purity in light of my high total cholesterol levels.

Can I infer with confidence that low carb diets help reverse arterial plaque, or at least prevent and/or suspend its ongoing accumulation?

Thanks in advance for any clarifications and added finger points you might offer here.

There are some interesting old studies looking at this very issue. They were done way back before lipophobia was collective fear of the nation. Researchers injected insulin into the legs of dogs. They would inject only one leg per dog, and they found that the arteries in the leg getting the daily insulin injection would develop atherosclerosis while the other leg (in the same dog) remained normal. When researchers quit injecting the insulin, the previously atherosclerotic leg would would return to normal. The conclusion from these studies was that excess insulin was a great driving force in the development of vascular disease. But, as I say, this data was presented before the advent of widespread lipophobia and has been assiduously ignored since. I have some anecdotal evidence from people involved in obtaining calcium scans of the coronary arteries, a much more accurate measure of risk for heart disease than lipid levels, who said patients who went on low-carb diets reduced their calcium scores whereas those on low-fat diets didn’t.

Do you rate carotid artery sonograms an accurate enough proxy for determining arterial plaque deposits, or are calcium scans the only way to go for a definitive diagnosis?

My father had arteriolosclerosis and part of what I recall from the pathology was his smaller arteries had higher incidence of buildup than the larger ones (e.g. carotid). Just curious if I might be missing something I should know about for later as I trundle towards my dotage… and battle the mainstream healthcare and Big Pharma system every step of the way.

I don’t know the correlation between the accuracy of a carotid artery sonogram and a cardiac calcium score, so I can’t answer your question precisely. But calcium scans are now going for about $200 (less in some places) so I would get one just to be sure. But I would look for someone who has an EBT machine vs a CT scanner as the radiation from the former is way, way, way less than the latter. I wouldn’t send someone for a calcium scan to anyone using a CT scanner because the radiation is much too high for a simple screening test.

Does anyone recommend someone to speak with in Australia about cholesterol? I did the original Protein Power diet 10 years ago and had great weight results but my blood chemistry did not change. Thanks.

I agree, cholesterol is deadly. Everyday in our meal includes cholesterol especially if we are not cautious to what we eat. Our daily consumption of cholesterol should be limited. To avoid this, avoid eating out at fast-food chains or restaurants. Home-cooked food is still better so you’ll be aware of how much intake of cholesterol you have consumed.

I don’t know what you’re agreeing with. Certainly not with me. I don’t have a problem with dietary cholesterol at all. Cholesterol is so important to good health that every cell in the body has the capability of manufacturing cholesterol if we don’t get enough in our diets.

I will be 50 in July and I’ve lived with “high cholesterol” almost my entire adult life. I have also struggled with the whole information vs. misinformation dilemma. No matter who you talk to, what book you read, or what website you stumble upon, it seems there is a lot of conflicting information. Too much of it at that.

I’ve been happy with my cholesterol readings for the most part–they were always around the 219 mark for many years. Then last year they went up to around 250. My doctor wanted me on Lipitor immediately, but as an intelligent and independent woman, I decided to do some research first. At the same time I was diagnosed with osteoporosis (a whole other ballgame with its own set of misinformation). When I opted out of taking drugs for cholesterol my doctor was clearly irritated with me, even going as far as telling me I was on the road to having heart disease. When I chose to avoid Reclast injections (which have caused death in women and men with osteoporosis) she looked me in the eye and told me I was going to break a hip. I surprised her by dropping that number down to 234 using diet and exercise, but I found another doctor because she was constantly pressing me to go on Reclast.

I had a physical yesterday and my new doctor was alarmed that my cholesterol had jumped to 288, with my HDL still falling into the normal range at 56, and my LDL standing at 207–too high according to the guidelines. My ratio is an average at 5:1. What surprises me about all this is that I went on a low-fat, low-cholesterol diet last year and lost 10 pounds. I’d like to lose another 8 or so, but I’m not too worried about it. I am within the normal range. I also started taking some supplements – mainly magnesium, calcium, D, K, and a multi – but I don’t take them every day.

I also started exercising last February (2010)–brisk walking (3.6 on the treadmill) for half an hour and weight-bearing exercise for 1/2 hour to 45 minutes. I can only do this about 3-4 times per week–sometimes less, as I have a neuromuscular disorder that makes my life a little rough at times. But despite the limitations, I have increased my flexibility and strength quite a bit. In fact, last year I couldn’t walk up a flight of stairs without stopping halfway up to catch my breath (this is also partially because of the neuromuscular issue) and now I can run up that same flight of stairs without batting an eye. I feel good–great even, when I’m not having a flareup (darn neuromuscular stuff).

So how is it that I ended up increasing my cholesterol in such a short time? Yesterday I was so worried about this, but I’ve been reading and I’m not so worried anymore. First of all, I don’t think I am at high risk of a heart attack. I eat a pretty healthy diet and have actually decided to add some cholesterol back into my diet. I have to wonder if my liver didn’t overcompensate somehow–is that possible? Since I suddenly, and drastically, reduced the amount of cholesterol I was consuming, could it be that my liver overreacted and went into overdrive on the cholesterol production? What is also strange to me is that less than a year ago my LDL was in the normal range and now it’s way high. I am concerned about that one.

I’m happy to have a doctor that isn’t quick to drop me into the pharmaceutical trap. He wants me to wait three months and recheck–along with my iron, as I was also borderline anemic. In the meantime I will be starting fish oil, and will also eat more fish. I think I’ll throw some red meat in there too, as I’m craving a steak like you wouldn’t believe!

Next, my grandmother’s cholesterol reading was always way up near 300, so I think I am genetically predisposed. Grandma did start taking meds sometime around 2000 and while her cholesterol did go down, it never went way down like some folks I know. But she never worried about it. She was always so low-key and accepting. And guess what? She died in September just two months shy of her 91st birthday.

“High cholesterol” runs on both sides of the family, but I have decided that I will do the best I can to keep it down without drugs. I believe the drugs to treat high cholesterol are toxic, and from what I’m learning, they cause the body to lose its own ability to keep cholesterol in check. In other words, once you’re on them, you have to stay on them. A similar problem is seen with long-term use of bisphosphonates used to treat osteoporosis.

When I look at the side effects of either of those drugs, I wonder how many studies have been done on people with myotonia or myotonic dystrophy. Probably not many, if any. I have enough muscle cramps and pain without the side effects of statins and bisphosphonates, both which are known to cause muscle cramps and pain, that I choose to avoid them and be in control of what is going into my body. I choose to steer clear of the drug bandwagon that everyone else seems to be so keen to jump on. At least for now.

In looking at your graphic, it seems that 3 of the 4 vectors loosely relate to the diet of paleolithic humans (pre-agriculture). Assuming that these people ate the entire animal nose-to-tail, I think they would only derive about 25 percent of their calories from saturated fats, unless I’m missing something (and I miss a lot). Yet today I see people claiming to derive 60 percent of their calories from saturated fats. Doesn’t this fly in the face of your evolution/anthropology/physiology vectors? Stated differently, when we were evolving into homo sapiens we did not have access to all the fat we wanted, but probably ate all the fat we could find. Isn’t a diet that derives 60 percent of its energy from saturated fats unnatural? I’m just trying to make the right bet..

I am losing my physician to a concierge model change and need to find another in the Denver/Boulder area that won’t go crazy about statins. My current doc doesn’t like my “fad diet” but is willing to listen and go along with my trying to lose weight and waist.

I tried Dr. Gerber in Littleton, but it did not work out. He seemed very nervous around me and preoccupied with his own knee surgery. I had come back for recommendations (I was to think about it) for his diagnosis of pre-diabetes. He brushed off his original diagnosis and said everything was fine. I had been doing low-carb for about 6 months and was not told to eat carbs for a few days prior to the test so I think the numbers were exaggerated. I bought a meter and tested for about a month. Averaged In the low 90s (I am 65).

I need to double down on the carb-restriction. I need someone to monitor my progress and not write prescriptions.

Do you know of any physicians that approved of low-carb in the area? I hate going to an appointment and not doing what a doctor suggests. My cholesterol is higher than desired but I have great Triglycerides and HDL. My LDL is large fluffy. My body naturally has a higher fat percentage and small muscle mass so it will take me awhile to change this.

After reading very much of your blog, and a few others, I got my husband to stop taking his cholesterol medications. He was having trouble sleeping and some anxiety…two things he never had before the meds. I ordered the CoQ10 and it just arrived. Does he need to take this with a fatty meal to get the full benefit? and I know I saw on some post you listed the supplements you took, but I can’t seem to find it now. I believe you said you did the Vitamin E with the Krill Oil? I feel sorta responsible for my hubby getting off the medication and I want to do all I can for his health now. Thanks, LInda

I’m another of those reading this article who has returned from a recent annual physical and received information about lipid levels. In sum, after eight months of very pleasurable low-carb and high fat eating, I have elevated my total cholesterol, in particular the LDL, to higher than the recommended level (according to my doctor).

Now I’m not particularly shaken by this. I had prepared myself with reading, especially Taubes, and your blog, and elsewhere. It still takes some spine, however, to listen patiently and silently to a doctor, who recommends avoiding everything I’m currently enjoying, and betting my life on. Not my job to tell him how to do his job.

Here’s what I’m wrestling with, sipping at the hosepipe of internet information.

How do the different measures of associations with low-risk for heart disease compare?

So if a person has, according to that same doctor, great HDL levels, great triglyceride levels, excellent blood pressure, excellent BMI (yes, I know, but it’s that same doctor), a healthy lifestyle, including regular exercise and resistance training, does the high LDL knock the legs out from under any of this? I find that difficult to believe. But I’d like to know, independent of belief.

But apart from having that LDL tested again (and finding out about pattern A, etc.) is there a gold-standard test that would satisfy a doctor (my poor strawman doctor above), which would establish reliably and verifiably whether or not this supposedly dangerously high LDL level actually increases my risk for coronary heart disease?

I recognize that no single (simple) metric can say I’m optimally healthy. And my heart will die eventually, along with the rest of me. And randomness in life can trump any of our best predictions.

I’m also interested in where to point a well meaning doctor to help bring us closer on this. It’s very important to have a good relationship with your primary care doc and I don’t want to be in conflict with mine over this. But I also don’t think I want to reduce dietary fat (current recommendation) and would not consider statins (next recommendation I’m sure).

Second paragraph: I should have clarified that my doctor recommends I avoid *eating* everything I currently enjoy (i.e. animal fats, saturated fats, shellfish, eggs, “red” meat, etc.), in order to reduce that high LDL count.

I am very interested in the whole dietary fat debate. I grew up in England (born 1957) where we ate bread and dripping, ate the fat on meat and butter, full fat milk (not homogenised back then) and full fat cheese – low fat products weren’t even invented back then. We didn’t over consume, we didn’t need to because we were nourished. I didn’t know one kid in primary or high school who was fat or even a bit overweight and no adults who were overweight.

Since embarking on low fat dieting my cholesterol counts have continued to go from bad to worse over the past few years. The low fat diet fad came from a study by Dr Ancel Keys in the 1970s. He was a cardiologist with an interest in heart disease. He studied 7 countries – 2 were Italy and Japan with very high carb diets but very little CVD disease. Some of the other countries were US, Canada, UK who had a high rise in fat consumption and were getting fatter and having more CVD incidences. From this he deduced that fat was the problem. What he didn’t take into consideration was that with the fat had come a big migration of sugar – think sugar coated donuts cooked in fat. He didn’t look at countries where the diet was high in fat but low in sugar – for example the Inuit (traditional Eskimos) whose diet was 80% fat but CVD was virtually unknown.

For a while now, I have been reading books such as Sugar Busters! and Sweet Poison and more recently have come across Dr Lustig who has a great video on You Tube of his lecture Sugar: the Bitter Truth. In which he points a finger firmly in the direction of sugar and more specifically fructose and high fructose corn syrup as having a big hand in the rise of obesity, CVD and other health problems. Dr Lustig is a paediatrician and endocrinologist working mainly with overweight children.

Not that sugar is the only factor by a long way, but when you think about how we have been eating low fat for 40 years now and we are still getting fatter, it makes a lot of sense. I would love to know what you think Dr Eades. I stopped eating low fat in August 2011 and am due for a cholesterol test so I will be very interested to see how it goes. I haven’t cut out all sugar – you still need to be able to eat birthday cake if you want to!

Well Jan, all I can say is you must be one in a million. Most people I know, including myself, lower their cholesterol levels on a low-fat diet and raise their levels on a high fat diet. The populations that are known for low cholesterol do NOT consume high fat diets. They eat low to lowish fat diets and plenty of carbs, some of which are refined! The traditional diet of the Okinawan’s is a prime example. I prefer to observe how the healthiest populations eat rather than listen to some charlatan trying to sell a book.

I suppose you’ve never heard of the Masai. They eat almost nothing but saturated fat and have very low cholesterol levels. Since there are so many more low-fat-loving pinheads such as your self out there, it would seem that a vile, moneygrubbing charlatan such as I could rake in many more shekels writing and selling low-fat diet books.

Ah yes, the Masai. You low-carbers always give them mention in an effort to legitimize your unhealthy diet. They are pastoralists that walk with their herds an average of about 20km in a day, every day! A lot more exercise than your average bacon and egg sucking low-carber I would be willing to bet. Never mind the fact that most die in their 50s. The fact is that the Masai develop do atherosclerosis. Another interesting fact about the Masai is that George Mann studied (autopsied) deceased Masai and determined that they had as much atherosclerosis as Americans, but because their blood vessels were more dilated, the atherosclerosis did not cause heart attacks. Gee, could there be a genetic reason the Masai don’t die from as many heart attacks?

Excuse me but if I want to name a population as a great example of health and longevity I’ll take the Okinawans over the Masai every time. Giving your your average reader the impression that high-fat is not only safe but healthy is irresponsible at best. More like criminal.

I am aware of all of Mann’s work with the Masai. You seem to attribute the lack of heart disease in the Masai to their genetics yet you attribute the longevity of the Okinawans to their diet. Do you see no lack of critical thinking here?

Can you cite me even one study – and I’m talking a randomized controlled trial here, not an observational study – showing that chowing down on eggs and bacon is bad for one? If you have such a study, I would like to see it.

As to my giving the average reader the impression that high-fat, low-carb diets are both safe and healthful is backed up by numerous randomized control trials. If you ever take the time to do a search of the scientific literature, you will find that when low-carb diets are studied head to head with low-fat diets, the low-carb diets, at the very worst, come out equal in terms of weight loss and in the majority of times greatly superior. I know your next thought. Yeah, you lose weight fast, but you clog your arteries in the process. Not a good trade. But, such is not the case. When low-carb diets are compared to low-fat in terms of improvement of cardiac risk factors, again, at worst, the low-carb diets hold their own while at best they totally trump low-fat diets. Look it up.

Actually, Mann attributes the lack of heart disease to genetics. I simply cited to his research on the subject. I doubt you would mention it yourself because you have books to sell. If you have a bone to pick with the conclussions I’d suggest you contact Mann. Low carb studies do nothing to address the long-term effects of consuming a high-fat diet. All low-carb does is pander to people’s love of their high-fat garbage diets. As far as the Okinawans are concerned, I’ve yet to see any research that suggests other non-lifestyle factors are key to their longevity. However, we do know that when they move to other countries or adopt a more western style diet they suffer from the same diseases we do with a shortening of their lifespans. So much for genetics. Nice try doc.

Where are the studies confirming the long-term benefits of the low-fat diet? Show me just one. Since the world went low-fat about 30 years ago, obesity has skyrocketed and diabetes is out of control.

It’s a cop out to attribute the genetic argument to Mann while using the old I-haven’t-seen-any-research-suggesting… argument about the Okinawans. If you’re going to make a serious case, back it up with hard data. You have none.

Talk is cheap, so if all you want to do is resort to ad hominem attacks instead of providing research, I’ll start deleting your comments.

As I’ve already stated in a previous replay to Jan, the low-fat craze in the 70s and 80s led to food companies producing a lot of low-fat and highly processed foods. That plus a lack of physical activity is a recipe for disaster. No wonder the North American low-fat craze was a failure. Unlike the low-fat diet pushed on the North American population, the high carb diets of healthy populations are not highly processed. So lumping all low-fat diets together is ridiculous. I cited Mann’s research and compared the Masai to the Okinawans, who have been extensively researched. The Okinawan track record in terms of health and longevity is no secret. Its out there for everyone to see. As you said to me earlier– “check it out”. I would imagine that if Mann’s research was favourable to the LCHF lifestyle you wouldn’t be referring to my citation as a “cop-out”. In fact, you’d likely be citing Mann yourself in your books. So, blaming the North American obesity epidemic on low-fat is really quite ludicrous when you have these healthy low-fat populations to observe. LCHFers choose to ignore them. That’s their choice. Ad hominem attacks? Apart from my first post, all subsequent posts dealt strictly with the topic, free of any ad hominem attacks. I apologize for my first post.

lastly, this is your blog. You can do what you want. I won’t be too shocked to find my comments removed.

Robert, maybe you should take your own advice and look up citation; wait, I’ll do it for you:

“Citation has several important purposes: to (1) uphold intellectual honesty, to (2) attribute prior or unoriginal work and ideas to the correct sources, to (3) allow the reader to determine independently whether the referenced material supports the author’s argument in the claimed way, and to (4) help the reader gauge the strength and validity of the material the author has used.[2]”

Well, you’ve hit one out of four and that ain’t bad for baseball; but it sure ain’t near enough for compelling argument with consenting adults. Keep trolling for cherry-picked abstracts some 40+ years old with n=50 samples as your citations and I’m sure you’ll spark an enlightening movement, most likely lower GI; or to paraphrase, more dung.

All the above aside, I’d really be interested if you have any direct access to raw data and independent analysis that is compelling, comprehensive and conclusive on the points you are asserting. My bet is that you don’t in the same regard that the low-carb theoreticians don’t yet have them either–there simply hasn’t been any such significant studies done to date to answer all the questions.

However, there is a significant growing body of practical and theoretical evidence that points to common sense conclusions from daily applications with repeatable and reputable results. And unfortunately for some the outgoing tide being against the previously conventional wisdom of high-carb, industrial foods and commercial sponsorship of charlatan marketing masquerading as nutritional science is leaving quite a few outspoken pundits naked and running for rhetorical cover. Both sides have their kooks and hacks, as I’m sure both sides have their sober and diligent, empirically motivated and disciplined adherents, like Dr. Mike.

So the question is which one are you trying to be? If you chill out on the ad hominem posturing and get to something interesting we’re more than happy to engage you an as intellectually honest and empirical truth seeking mind.

And if not, or you don’t care what others think about you, that’s really quite fine too. Peace out and eat what you like when you like.

So you call my citation of Mann’s study on the Masai cherry-picking? There isn’t a lot of research on the Masai to begin with so you’ll just have to accept what is available. I didn’t even bring up the subject of the Masai in the first place. That was your Dear Leader that did that. I merely cited a study that showed the Masai have some sort of genetic advantage. Using the Masai as an excuse to continue eating your bacon/cheese burgers (minus the bun of course) is very weak, not to mention irrelevant. I have another study that shows the Masai were found to have a genetic advantage:

“The cholesterol metabolic study was designed
to investigate its homeostatic mechanisms
and involved 24 healthy, adult Kenyan
Masai students. One-half of them were on a
cholesterol-free, semisynthetic diet and the
other half were fed a diet supplemented with
2 g cholesterol in their daily ration. By mixing
a daily trace dose of cholesterol-4-14C in the
diets of both groups of subjects, it was possible
to determine the rate of absorption of
dietary cholesterol and the synthesis, excretion,
turnover, and pool size of body cholesterol.
The results indicate that the Masai have
a much larger capacity for intestinal cholesterol
absorption than whites and a greater
ability to suppress endogenous cholesterol
synthesis, averaging 50.5%, for compensation
of their intestinal absorption of dietary
cholesterol. This efficient feedback control is
the only homeostatic mechanism that protects
the Masai from developing hypercholesteremia.”

Due to the limited number of studies done concerning the Masai, one does not have the luxury of cherry-picking the “best” ones. One takes whatever one finds.

There was another study conducted by Dr. Julia Mbalilaki that concluded that the 20km hikes that the Masai take each day may be the reason the Masai don’t have more heart disease. However, Mann’s study and the authors of the study cited above have concluded that the Masai do indeed have a genetic advantage.

What the Masai have in common with your average LCHF dieter from the USA is beyond me. As I said, your Dear Leader chose to bring the Masai up as an example. They are, in fact, a terrible example to use here unless you are also a Masai. I’m guessing that most of you here are not. (sarcasm intended)

Rob I am pretty special I have to admit! It sounds as if you are quite unaware of the every increasing cholesterol levels since the advent of low fat dieting in the 1970s, obviously low fat dieting does not suit a very large proportion of the population, me included. I also wonder if you have had a little help from statins to lower your cholesterol?

How do you explain that the Inuit traditional diet is 80% fat but they remain healthy with very low incidences of heart problems and other diseases of the Western world – and I am talking about the 100% traditional diet here, not traditional amalagamated with Western diet.

Although I would like to consider myself one in a million, I have other friends who have battled to keep their cholesterol under control with low fat diets but hey, that leaves a great niche for big pharma to fill with their statins. Through catching up with the latest news on blogs such as this one, people such as myself can find alternatives to low fat dieting and big pharma.

There are many, many doctors now who have come out and flat out stated how wrong low fat dieting is and thank goodness for docs such as Michael who have the guts to come out and say there may be a better/different way!

There are healthy low-fat diets then there are unhealthy ones. During the low-fat “craze” in North America, food manufacturers came out with a lot of low-fat but unfortunately, processed food products. People were eating low-fat diets but the quality of the food was not good. It contained a lot of processed (refined) garbage that I wouldn’t touch if you paid me. You other comment about statins and whether or not I’ve needed them seemed rather odd to me but to answer your question, if that’s what it was, the answer is no. Never used them, never needed them. The only time my cholesterol increased was when I tried a diet similar to what Eades, Taubes, et al, recommend. Lowering the fats in my diet caused my cholesterol to drop from 236 to 180. Haven’t had it checked in a year so I don’t know what it is now. I wouldn’t the Inuit or the Masai as examples of great health. I responded to Dr. Eades on this matter but he has not, as yet, seen fit to approve it.

Ah, the mystery of your contentiousness is solved. You are one of the ones whose cholesterol went up on a low-carb diet, and have spent all your time since vilifying them.

Were you better schooled in the subject of lipidology, you would know that total cholesterol levels are virtually meaningless. It’s a complicated story, but the real danger in lipid is in the number of particles of LDL one has, not the amount typically measured (it’s actually calculated, not typically measured directly) in a cholesterol test. Low-carb diets tend to increase the size of LDL particles so that sometimes the lab number goes up, but the particle number goes down. Because the actual LDL level isn’t measured, the formula used to calculate it is, in my opinion, faulty. Click the link for an explanation of why the Friedewald equation is incorrect in low-carb dieters.

Ah, the LDL particle size gambit. The last line of defense for the low-carb/high-fat crowd. The fact is that there are healthy, long-lived populations that follow a low-carb diet. The best examples we have of low-carb populations are the Inuit and the Masai (and other pastoralists) and of course our Paleolithic ancestors. Unfortunately for the LCHF crowd, none of them live, or have lived, very long. There you have it. Everything about low-carb is short-duration. The few populations that follow a LCHF have shorter lifespans and the LC studies don’t address long-term outlooks. One last thing: If LCHF diets were found to be superior over low fat diets (even over the long-term), I’d be fine with that because science isn’t about winning an argument, its about discovering the truth. I don’t have any investment in any diet so it matters little. You, on the other hand, have an investment on being correct so it is in your best interest to remain an apologist for the LCHF lifestyle.

My son called and told me his doctor wanted him to lower his LDL with a low fat diet or go on a statin. I told him to cut back on bread, pasta, rice, etc and eat plenty of saturated fat. He said, “Mom, let me get this straight. Are you telling me to do the exact opposite of what the doctor said?” I said, “Yes, I am.”
Since his triglycerides were well under 100, I also told him to google for the Iranian formula. After he read the paper, he asked his doctor for a direct LDL and it was about 15 points lower than the calculated number, so no diet at all.

Thank you. I started a low carb diet 2 months ago after being in and out of doctor’s offices for over a year with worsening symptoms. 13 years of problems with my digestive health culminating in a very difficult and scary year and a half. It’s hard to get a good doctor where I live. I had been presenting symptoms that resemble fibromyalgia, and I have been turning everything right around on a low-carb diet!!

Have you seen the new Time magazine coming out this week telling us all to “Eat Butter”? I’m much more excited to read that issue than I’ve ever been in their views on cholesterol. Finally, the truth comes out…